Hypermenstrual syndrome

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

Bleeding from the genitals can occur at different age periods of a woman’s life, but it most often occurs during the reproductive period.

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Epidemiology

Although hypermenstrual syndrome remains the leading reason for visits to the gynecologist, only 10-20% of women experience serious problems associated with blood loss during menstruation.

Any woman of reproductive age who has periods can develop menorrhagia, most often occurring in her 30s.

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Causes hypermenstrual syndrome

• Inflammatory processes of the uterus and appendages:
  • genital infection.
• Endocrine pathology:
  • primary hypothalamic-pituitary dysfunction;
  • secondary ovarian dysfunction associated with pathology of other endocrine glands of 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 of the uterus (choriocarcinoma, sarcoma, adenocarcinoma, cervical cancer);
  • hormonally active ovarian tumors.
• Traumatic and surgical injuries of the genitals.
• Hematological diseases:
  • hemorrhagic diathesis;
  • thrombocytopenia;
  • leukemia;
  • toxic-allergic damage to the walls of blood vessels.
• Somatic and infectious diseases, intoxications.
• Iatrogenic causes:
  • inappropriate use of estrogens, anticoagulants;
  • intrauterine contraception.

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Risk factors

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

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Pathogenesis

The development of hypermenstrual syndrome may be associated with both the slow rejection of the thickened mucous membrane of the uterus against the background of a relative or absolute excess of estrogens, and its slow regeneration at the end of the next menstruation. In the dynamics of the development of the pathogenetic process, hypermenstrual syndrome is a less severe stage of menstrual cycle disorder compared to hypomenstrual, since it develops under conditions of preserved estrogen production by the ovaries.

In approximately 25% of patients, bleeding occurs as a result of organic lesions of the genital organs, and in other cases it is caused by dysfunction of the hypothalamic-pituitary-ovarian system.

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Forms

The following forms of hypermenstrual syndrome are distinguished:

• Hyperpolymenorrhea - heavy and prolonged menstruation.
• Menorrhagia is bleeding during menstruation.
• Metrorrhagia is bleeding outside the normal menstrual period.
• Menometrorrhagia is a combination of meno- and metrorrhagia.
• Acyclic bleeding - there is no cyclical pattern of bleeding from the genitals.

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Complications and consequences

Occasional episodes of menorrhagia usually do not pose serious risks to a woman's overall health.

Patients who consistently lose 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 bleeding is heavy enough, women may experience shortness of breath, fatigue, and palpitations.

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Diagnostics hypermenstrual syndrome

Age is the most important factor determining the approach to patients suffering from bleeding. It is this factor that influences the choice of the nature and scope of examination and treatment methods (for example, exclusively conservative ones during puberty in case of juvenile bleeding), the urgency of hospitalization (if there is a suspicion of oncopathology in pre- and postmenopause). It is also taken into account when classifying the causes of bleeding and developing an algorithm for diagnostic and therapeutic measures, identifying diseases characteristic of a certain age.

Diagnosis involves taking a medical history followed by a physical examination and performing an ultrasound of the pelvic organs. Laboratory tests are performed if necessary. Below is a list of diagnostic procedures that gynecologists may 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 rule out endometrial cancer or atypical hyperplasia.
• Hysteroscopy.

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Treatment hypermenstrual syndrome

In some cases, emergency assistance is required.

Conservative medicinal treatment

First line

• Intrauterine device with progesterone.

Second line

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

Third line

• Progestogens (eg, norethisterone, Depo-Provera).

Other options

• Gonadotropin-releasing hormone agonists.

Cases of significant blood loss require hospitalization for intravenous fluids and blood transfusions and/or estrogen therapy. Patients who do not respond to conservative therapy may require surgical intervention.

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Surgical treatment options

• Endometrial ablations
• Uterine artery embolization
• Hysteroscopic myomectomy for fibroid removal

Forecast

Increased blood loss, which is typical for it, can lead not only to loss of life comfort, ability to work, but also threaten health, and in some cases, the life of a woman. With proper diagnosis, timely and effective treatment and subsequent care, the prognosis is favorable.

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