Menorrhagia refers to a medical condition in which menstrual bleeding occurs in excessive amounts and lasts for a long time. For many women, this condition of menorrhagia can be a hindrance in carrying out daily activities during menstruation.

Excessive bleeding is not only annoying, but can also cause intense stomach cramps, known as dysmenorrhea. This can simultaneously affect the comfort and quality of life during this period.

Symptoms of Menorrhagia

Women who experience heavy or prolonged bleeding will usually experience one or more of the following symptoms in general:

1. It is often necessary to change pads every 1-3 hours in the early days of menstruation.
2. Menstruation lasts more than 7 days.
3. Sometimes you have to use more than one pad at the same time because of the very high volume of bleeding.
4. Need to change pads during the night while resting.
5. Sometimes blood clots that are more than 2.5 cm in size come out.
6. Daily activities may be limited due to profuse bleeding.
7. There are symptoms of anemia such as excessive fatigue, feeling weak, or difficulty breathing.

Causes of Menorrhagia

In some cases, the cause of menorrhagia is unknown. Even so, there are a number of conditions that generally cause this heavy menstruation, such as:

• Ovarian Dysfunction. When the ovary does not release an egg (ovulation) during the menstrual cycle (anovulation), the body is then unable to produce the hormone progesterone, as occurs during a normal menstrual cycle. This causes hormonal imbalance and can cause menorrhagia.

• Uterine Fibroids. These noncancerous (benign) uterine tumors appear during the childbearing years. Uterine fibroids can cause menstrual bleeding that is heavier than normal or prolonged.

• Polyps. Small, benign growths on the lining of the uterus (uterine polyps) can cause heavy or prolonged menstrual bleeding.

• Adenomyosis. This condition occurs when glands from the endometrium become embedded in the uterine muscle, often causing heavy bleeding and painful menstruation.

• Intrauterine Device (IUD). Menorrhagia is one of the most common side effects of using non-hormonal contraceptives for birth control.

• Pregnancy Complications.Single, heavy and late menstruation may be caused by a miscarriage. Other causes of heavy bleeding during pregnancy include an unusual location of the placenta, such as a low lying placenta or placenta previa.

• Cancer.Uterine cancer and cervical cancer can cause excessive menstrual bleeding, especially if you are postmenopausal or have had an abnormal Pap test in the past.

• Inherited Bleeding Disorders. Some bleeding disorders, such as von Willebrand's disease. This condition is caused by impaired blood clotting factors which can cause abnormal menstrual bleeding.

• Drugs. Types of anti-inflammatory drugs, hormonal drugs such as estrogen and progestins, and anticoagulants such as warfarin or enoxaparin can cause heavy or prolonged menstrual bleeding.

• Other Medical Conditions. A number of other medical conditions, including liver or kidney disease, can be associated with menorrhagia.

Menorrhagia Treatment

Treating menorrhagia requires the right approach, adjusted to the root cause and the severity of the patient's condition. There are several treatment methods that can be applied to help people with menorrhagia regain comfort:

1. Appropriate Drug Therapy

Doctors can prescribe a variety of medications to treat menorrhagia, including:

• Antifibrinolytic Drugs. Like tranexamic acid, it helps reduce excess bleeding by strengthening blood clotting.

• Nonsteroidal Anti-Inflammatories (NSAIDs). Such as ibuprofen, naproxen, and mefenamic acid, relieve pain and reduce the production of prostaglandins that trigger menorrhagia.

• Combined Contraception, helps regulate the menstrual cycle, reducing the duration and amount of blood released during menstruation.

• Desmopressin, useful for treating bleeding due to von Willebrand's disease.

• Hormone Therapy such as injectable progestogens and oral norethisterone, help regulate hormone levels and reduce bleeding.

• Analog GnRH-a, reduce bleeding, improve cycles, and reduce the risk of complications.

• Iron Supplements, important for menorrhagia patients who have anemia. In cases of heavy bleeding, hospitalization with blood transfusions can be a solution.

2. Measured Operation Steps

If drug therapy is not effective enough, surgical procedures may be an option:

• Dilation and Curettage (D&C): helps reduce bleeding by scraping the uterine wall.

• Uterine Artery Embolization: effective in treating menorrhagia due to myoma by blocking the blood supply.

• Myomectomy: There are two types of surgical removal of myoma, namely laparoscopy and hysteroscopy.

• Endometrial Removal (Resection): removes the endometrial layer with a heated wire.

• Endometrial Ablation: permanently destroying the endometrial lining by various methods.

• Hysterectomy: the last step if other options don't work, stopping menstruation and the ability to get pregnant.

To effectively prevent menorrhagia, it is important to have regular check-ups by your doctor, especially if you have risk factors for menorrhagia. This step will not only make you more comfortable with your period, but will also allow your doctor to take immediate preventive action if symptoms of excessive menstruation start to appear.

References:

https://www.alodokter.com/menorrhagia

https://www.halodoc.com/kesehatan/menoragia

https://bocahindonesia.com/menorrhagia-perdarahan-menstruasi-berlebihan/