Hypermenstrual syndrome

Hypermenstrual syndrome (menorrhagia) - an increase in the volume and duration of menstruation up to permanent bleeding.

Bleeding from the genitals can occur in different age periods of a woman's life, but most often they occur in the reproductive period.

[1], [2]

Epidemiology

Despite the fact that hypermenstrual syndrome remains the leading cause of visits to a gynecologist, only 10-20% of women experience quite serious problems associated with loss of blood during menstruation.

Any woman of reproductive age who has a menstrual period can develop menorrhagia, most often they occur at the age of 30 years.

[3], [4], [5], [6], [7], [8]

Causes of the hypermenstrual syndrome

• Inflammatory processes of the uterus and appendages:
  • genital infection.
• Endocrine pathology:
  • primary hypothalamic-pituitary dysfunction;
  • secondary disorders of ovarian function associated with the pathology of other endocrine glands in the body.
• Organic diseases of the uterus and ovaries:
  • hyperplastic processes of the endometrium (glandular hyperplasia, endometrial polyps, atypical hyperplasia);
  • benign tumors of the uterus (fibromyoma);
  • adenomyosis (endometriosis of the uterus);
  • malignant tumors of the body and cervix (choriocarcinoma, sarcoma, adenocarcinoma, cervical cancer);
  • hormone-active tumors of the ovaries.
• Traumatic and operating injuries of the genital organs.
• Hematological diseases:
  • hemorrhagic diathesis;
  • thrombocytopenia;
  • leukemia;
  • toxic and allergic damage to the walls of blood vessels.
• Somatic and infectious diseases, intoxication.
• Iatrogenic causes:
  • inadequate use of estrogens, anticoagulants;
  • intrauterine contraception.

[9], [10]

Risk factors

• mental depression;
• adverse living conditions;
• climate change;
• smoking.

[11], [12], [13]

Pathogenesis

The development of hypermenstrual syndrome can be associated with both delayed rejection of the thickened mucous membrane of the uterus against the background of relative or absolute excess of estrogens, and slowed-down regeneration at the end of the next monthly. In the dynamics of the development of the pathogenetic process, hypermenstrual syndrome is a less severe stage of menstrual irregularity compared with hypomenstrual, as it develops under conditions of preserved production of estrogen by the ovaries.

Approximately 25% of patients bleed due to organic lesions of the genital organs, and in other cases they are caused by violations of the hypothalamic-pituitary-ovarian system.

[14], [15], [16], [17],

Forms

There are following forms of hypermenstrual syndrome:

• Hyperpolymenorrhea - abundant and prolonged period.
• Menorrhagia - bleeding at the time of menstruation.
• Metrorrhagia - bleeding beyond the periods of menstruation.
• Menometrorrhagia is a combination of meno- and metrorrhagia.
• Acyclic bleeding - the cycle of bleeding from the genital organs is completely absent.

[18], [19], [20], [21]

Complications and consequences

Rare episodes of menorrhagia usually do not pose serious risks to the overall health of women.

Patients who lose constantly more than 80 ml of blood are at risk of developing iron deficiency anemia as a result of chronic blood loss. Hypermenstrual syndrome is the most common cause of anemia in premenopausal women. If the bleeding is severe enough, women may experience shortness of breath, fatigue, palpitations.

[22], [23]

Diagnostics of the hypermenstrual syndrome

Age is the most important factor determining the approach to patients suffering from bleeding. It influences the choice of the nature and scope of the methods of examination and treatment (for example, exclusively conservative during puberty in juvenile bleeding), the urgency of hospitalization (with pre-and postmenopausal oncology suspected). It is also taken into account in the classification of the causes of bleeding and the development of an algorithm of diagnostic and therapeutic measures, highlighting diseases characteristic of a certain age.

Diagnosis is the study of the medical history followed by physical examination and ultrasound of the pelvic organs. If necessary, laboratory tests are carried out. Below is a list of diagnostic procedures that gynecologists can use to determine the cause of hypermenstrual syndrome:

• Rectal examination.
• Pap smear to rule out cervical neoplasia.
• Ultrasound of the pelvic organs.
• Endometrial biopsy to exclude endometrial cancer or atypical hyperplasia.
• Hysteroscopy.

[24], [25], [26], [27]

Treatment of the hypermenstrual syndrome

In some cases, emergency care is required.

Drug conservative treatment

First line

• Intrauterine spiral with progesterone.

Second line

• Tranexamic acid with antifibrinolytic agents.
• Non-steroidal anti-inflammatory drugs (NSAIDs).
• Combined oral contraceptives.

Third line

• Progestogens (for example, norethisterone, Depo-Provera).

Other options

• Gonadotropin-releasing hormone agonists.

Cases of significant blood loss require hospitalization for intravenous infusion and blood transfusion and / or estrogen therapy. Patients who do not respond to conservative therapy may need to undergo surgery.

[28], [29], [30], [31],

Variants of operative treatment

• Endometrial Ablation
• Embolization of uterine arteries
• Hysteroscopic myomectomy for myoma removal

Forecast

Increased blood loss, characteristic of him, can lead not only to loss of comfort, ability to work, but also to threaten health, and in some cases, life of a woman. With proper diagnosis, timely and effective treatment and follow-up care, the prognosis is favorable.

[32]