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Hypermenorrhea and menorrhagia: causes, tips

by Josephine Andrews
Published: Last Updated on 310 views

Hypermenorrhea and menorrhagia are among the most common menstrual cycle disorders and often occur together. This results in menstrual bleeding lasting at least seven days (menorrhagia) and increased blood loss (hypermenorrhoea) of more than 80 ml per cycle. The causes for this are varied and mostly not life-threatening. Triggers are, for example, changes in the genitals or hormone fluctuations. Read what causes hypermenorrhea and menorrhagia and what you can do about it!

Hypermenorrhea and menorrhagia: description

Normal menstrual cycle

Normally, women have a menstrual period about every 28 days if a fertilized egg has not implanted in the lining of the uterus . The bleeding usually lasts four to five days, then the menstrual cycle starts all over again. Menstrual fluid is made up of blood and parts of the lining of the uterus. On average, a woman loses around 40 ml of blood with each menstrual period. A cycle is counted from the first day of the menstrual period and the last day before the next menstrual period. Cycle lengths of 25 to 35 days are considered normal and are common.

Menorrhagia and hypermenorrhea – too long and heavy menstrual bleeding

Menorrhagia and hypermenorrhoea (hypermenorrhoea) result in prolonged menstrual bleeding and/or increased loss of blood. A prolonged menstrual cycle contributes to increased blood loss, which is why hypermenorrhea and menorrhagia often occur together. The causes of both menstrual disorders are often the same.

Doctors speak of menorrhagia when menstruation lasts more than seven days. With pronounced menorrhagia, the bleeding can extend up to two weeks. Hypermenorrhea describes increased menstrual bleeding with a blood loss of more than 80 ml during one menstrual period.

Increased, prolonged menstrual bleeding is quite uncomfortable for those affected and has a decisive impact on everyday life, work and sex life. Due to the high blood loss, many women suffer from tiredness , exhaustion, exhaustion, circulatory problems and anemia. Iron is also lost with the blood – it can even lead to iron deficiency anemia.

Hypermenorrhea and menorrhagia: causes and possible diseases

In young women going through puberty and women going through the menopause, harmless hormonal fluctuations are usually responsible for bleeding that is too heavy or lasts too long. Another cause are changes in the area of ​​the female sex organs. But stress and other non-gynecological diseases are also possible. Very rare causes are high blood pressure , kidney, liver and heart diseases as well as blood clotting disorders (also taking anticoagulants).

You can read more about the most common forms, symptoms and causes of menstrual disorders in our article on irregular menstrual cycles.

Important causes of hypermenorrhea and menorrhagia

Fibroids (uterine fibroids) – benign muscle growths in the uterus: Fibroids form benign lumps in the muscles of the uterus, so-called uterine fibroids. They can expand further, for example into the interior of the uterus or into the abdomen. Fibroids are relatively common and often do not cause any symptoms, which is why they are often discovered by accident. However, they can trigger heavy menstrual bleeding, which also lasts longer than normal.

Endometriosis – Overgrowth of the lining of the womb: Endometriosis is a benign disease of the lining of the womb (endometrium). The mucous membrane of the womb (uterus) also grows outside the womb in other parts of the body. Common places are the outer wall of the uterus and the connective tissue of the uterus, the ovaries but also the peritoneum. These endometrial lesions are also subject to the normal menstrual cycle and consequently bleeding occurs at multiple sites. This often triggers severe symptoms such as heavy, long-lasting menstrual bleeding and severe menstrual pain .

Generally increased tendency to bleed: in women who generally have an increased tendency to bleed, this is also the cause of heavy menstrual bleeding.

Polyps – benign growths of the mucous membrane: Polyps can form on the cervix (cervical polyp) or in the area of ​​the uterus (uterine polyp). Unlike the rest of the uterine lining, polyps are not shed during menstruation. Polyps can also cause menorrhagia or hypermenorrhea.

Inflammation of the lining of the womb (endometritis): Here the lining of the womb (endometrium) is inflamed. The causes are pathogens (e.g. chlamydia) that reach the cervix via the vagina and penetrate into the uterus. Endometritis can cause excessive bleeding, bleeding between periods, and unusually painful bleeding.

Inflammation of the fallopian tubes (salpingitis): Here, too, bacteria that rise from the vagina trigger the infection. The pathogens pass from the vagina via the cervix into the uterus and the fallopian tubes. Inflammation of the fallopian tubes can manifest itself, among other things, in increased, prolonged bleeding.

Cancer of the uterus (uterine carcinoma): These are malignant changes in the uterus. The first symptom of uterine cancer is bleeding from the uterus through the vagina, which resembles menstruation. Vaginal bleeding that occurs after menopause is particularly suspicious.

Disorders of the thyroid function: An overactive thyroid gland (hyperthyroidism) or an underactive thyroid gland (hypothyroidism) can also lead to cycle disorders and thus to a longer, heavier period.

IUD : Especially in the first period after inserting a copper IUD, menstrual bleeding increases in many women. With hormonal IUDs, on the other hand, the bleeding can be reduced or even stopped altogether.

Chlamydia: In some cases, infection with chlamydia also leads to increased blood loss and a longer cycle interval.

Hypermenorrhea and menorrhagia: when do you need to see a doctor?

Unusually heavy and/or long menstrual periods require a medical examination. Even if severe symptoms such as severe abdominal cramps and circulatory problems occur during the period, this should be clarified by a doctor. The amount of hygiene products (pads, tampons or menstrual cups) used during a bleeding serves as a guideline for blood loss. If this number increases to a greater extent, this should be discussed with the gynecologist or family doctor.

Always pay attention to the length and strength of the menstrual bleeding and discuss any major deviations with your gynaecologist.

What does the doctor do if the menstrual cycle is too heavy or lasts too long?

diagnosis

In order to diagnose hypermenorrhea or menorrhagia, the doctor first asks about your menstrual cycle and your symptoms ( anamnesis ). The focus is on, among other things, the frequency of bleeding, bleeding intensity, pain or possible bleeding between periods.

This is followed by a gynecological examination with a palpation examination of the vagina and cervix as well as an ultrasound examination . Sometimes the cervix is ​​viewed with a special microscope ( colposcopy ). In women of childbearing age, a pregnancy test is usually also carried out.

blood test shows whether hormone disorders or iron deficiency anemia or iron deficiency are present. The values ​​for hemoglobin , iron (also in its storage form ferritin ) and thrombocytes are determined . A urinalysis can also provide indications of a hormone imbalance . The cancer smear allows conclusions to be drawn as to whether malignant cells or precursors of cancer are present. A pathologist examines the cells under a microscope. Sometimes further examinations such as computed tomography or magnetic resonance imaging follow .

At the same time, a hysteroscopy is almost always performed, in which an optical instrument with a light source is inserted into the interior of the uterus. Polyps, for example, can be removed directly via a separate channel and then examined for histological examination.

therapy

The treatment of menorrhagia or hypermenorrhea depends on the cause. Organic changes such as uterine fibroids, polyps of the uterus or cervix can be surgically removed or treated with drugs (e.g. with hormones), depending on their location and size. If a malignant change in the uterus is suspected, the lining of the uterus is first scraped out ( abrasio ).

Endometrial ablation destroys and removes the lining of the uterus that causes heavy menstrual bleeding. The uterus itself is preserved. The operation is performed through the cervix. The complaints should then be resolved.

In the case of hormonal disorders , hormonal treatment is possible. Progestogens and GnRH analogues are usually used. Hormones are also used for endometriosis and fibroids. In women who do not want to have children, good results can be achieved with hormonal contraceptives (e.g. the pill ). In very rare cases – if all therapeutic attempts are unsuccessful and the general condition of the woman is severely impaired – removal of the uterus ( hysterectomy ) can be considered once the family planning is complete.

Menorrhagia: You can do this yourself

You cannot prevent hypermenorrhea or menorrhagia yourself, but there are some tips that you can use to positively influence the menstrual cycle and your well-being. A healthy lifestyle is paramount:

Get rid of stress: Develop a relaxation method that you use regularly. This could be yoga, progressive muscle relaxation according to Jacobson or autogenic training . This is how you keep stress at bay.

Exercise regularly ! Endurance sports such as swimming , cycling, Nordic walking or hiking are best . Regular exercise balances the body and soul and also has a positive effect on menorrhagia. Around 30 minutes of exercise a day is recommended, ideally on all seven days of the week.

Eat right: Eat a balanced diet with little fat or healthy fatty acids and lots of fresh fruit and vegetables. Avoid frequent fast food and ready meals.

Watch your weight: By eating a balanced diet, you can avoid putting too many pounds on your hips.

Get enough sleep – this also has a positive effect on your well-being.

Avoid excessive alcohol and nicotine consumption , this is good for your health.

Prevention: Sexually transmitted infections can also trigger hypermenorrhea or menorrhagia. Condoms can protect against this. Take regular gynecological check-ups! The doctor recognizes changes in the sexual organs, infections, precancerous lesions or cancer and can treat them at an early stage.

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