Written by Dr. Sarika Doshi

Menorrhagia means an excessive menstrual flow. It can be divided into 3 main groups according to the age.

1. Menorrhagia at Puberty
   
2. Menorrhagia at child bearing age
3. Menorrhagia at Menopause

1. Menorrhagia at Puberty

   It coincides with the onset of menses. The bleeding may be continuous or it may be with short intervals in between or it may be protracted or prolonged type of period lasting for days.

   Causes:

   • In great majority of cases, the underlying cause is Pituitary or Ovarian dysfunction similar to that occuring in the later life i.e. at Menopause.
   
   
   • There may be Hyperthyroidism or sometimes hyperfunction of the thyroid gland with deficiency of Calcium in the blood.
   
   
2. Menorrhagia at child bearing age

   The causes of this Menorrhagia may be classified into

   • General causes
   • Local causes
   
   
   • General causes
   
   
   1. Blood diseases like pernicious Anaemia, Pupeura or Scurvy.
   
   
   2. Chronic Nephritis because it raises the blood pressure.
   
   
   3. Nervous diseases like mania.
   
   
   4. Use of Alcohol.
   
   
   5. Hot climate.
   
   
   6. Endocrinal factors; too frequent ovulation resulting in shortening of menstrual cycle.
   
   
   • Local causes
   
   
   1. Infection of the uterus, tubes, ovaries and pelvic peritoneum.
   
   
   2. Metropathia Haemorrhagica: It is a condition in which the uterus is likely to bleed excessively.
   
   
   3. New growth in the uterus; e.g.fibroids, adenoids etc.
   
   
   4. New growth in the ovaries, tubes and retaintion cysts of the ovaries.
   
   
   5. Displacement of the genital organs especially the uterus.
   
   
3. Menorrhagia at Menopause

   Causes:

   • Hyperthyroidism after cessation of ovarian secretions; such patients are usually very irritable and may have tremors.
   
   
   • Unequal ovarian activity: This may cause irregular menorrhagia owing to the atrophying ovaries which do not produce much secretions to bring on the menses at the proper time. When enough secretion is produced, profuse and protracted bleeding occurs.
   
   
   • Tumours: Cancer is the most important cause as the woman is more than 45 years of age.
   
   
   • Fibrosis of the muscular wall of the uterus and of its blood vessels; they become hard and thus crack.
   
   
   • Fibrosis of endometrium due to old age. Here all the menstrual blood does not escape owing to the density of the fibrosis and, therefore, small collections of blood are scattered here and there under the endometrium. This acts as the foreign body and nature wants to throw it out in menorrhagia and so menorrhagia occurs.
   
   
   
   

   General Treatment:

   • Rest in bed.
   
   
   • Removal of underlying cause as far as possible.
   
   
   • Liquid nourishing diet.
   
   
   • X-ray or radiation should not be allowed.