Menstruation is defined as periodic, spontaneous uterine bleeding, which expels the endometrium of an ovulatory cycle. In the normal menstrual period, the average duration of the cycle is 21 to 35 days, the volume of bleeding is 30 to 80 ml and the duration is calculated from 2 to 7 days. Hypermenorrhea (or menorrhagia) refers to a menstruation at regular intervals that is increased in quantity (more than 80 ml) and does not exceed 7 days.
Reports from the World Health Organization indicate that 18 million women aged 30 to 55 years perceive their menstrual bleeding as excessive. Reports show that only 10% of these patients experience blood loss severe enough to cause anemia or to be clinically defined as menorrhagia.
In practice, the measurement of menstrual blood loss is difficult. Therefore, the diagnosis is usually based on the patient’s history. Excessive bleeding is considered when there is one or two saturated napkins or tampons in a maximum time of 3 hours, a number of used sanitary towels greater than 7 a day, or both.
Menorrhagia should be distinguished clinically from other common gynecological diagnoses. This includes metrorrhagia (flow at irregular intervals), menometrorrhagia (frequent, excessive and prolonged flow), polymenorrhoea (bleeding at shorter intervals than 21 days) and dysfunctional uterine bleeding (abnormal uterine bleeding, without obvious structural or systemic abnormality, usually anovulatory).
So, for menstrual bleeding to be properly controlled, it is necessary that the myometrical contractility is sufficient, the epithelization of the endometrial mucosa has not suffered alterations and blood coagulation occurs normally.
Causes of Heavy Periods
Any process produced by various causes, whether genital or extragenital, or both types at the same time, and that alters any of these mechanisms, can cause hypermenorrhea. However, less than 50% of the cases have an identified cause.
The most common anatomical causes of hypermenorrhea are uterine myomatosis, especially submucosal myomas, and endometrial polyps. In the presence of uterine pathology (myomas / adenomyosis and to a lesser extent endometrial polyps), disturbances in the production and / or release of angiogenic factors (vascular endothelial growth factor [VEGF], fibroblast-derived growth factor [FGF] and factor growth transforming beta [TGF-B]) may be the underlying disorder of the vascular fragility.
At Harley Street Hospital, we have the best doctors who are trained to diagnose and properly treat these conditions. Book a consultation to get a specialist´s opinion.