MENORRHAGIA - Causes, Complications & its Treatment - Ayurvedaacharya

WHAT IS MENORRHAGIA ?

Menorrhagia is defined as cyclic bleeding at normal intervals; the bleeding is either excessive in amount or duration or both. If the amount is more than 80 ml and the duration is more than 7 days is considered menorrhagia.

Heavy or prolonged bleeding during the menstrual cycle affects the physical, emotional, day-to-day activities, social life, occupation, sexual life and maternal quality of life. The causes of menorrhagia are not only organic and function, many factors such as lifestyle, diet, mental state and hormonal imbalance. The term menotaxis is often used to denote prolonged bleeding.

Metrorrhagia is defined as an irregular, acyclic bleeding from the uterus. The amount of bleeding is variable.

CONCEPT OF AYURVEDA

In Ayurveda ‘Asrgdhara’ or ‘Rakthapradara’ is menorrhagia. ‘Asrg’ means blood and ‘Dhara’ means excessive flow. Asrgdhara is manifested by unhealthy food habits and activity both Raktha and pitta Dhatu vitiated and leads to heavy menstrual blood flow.

WHAT ARE THE CAUSES OF MENORRHAGIA ?

Menorrhagia is a symptom of some underlying pathology—organic or functional.

Organic

Pelvic Pathology:

Due to congestion, increased surface area, or hyperplasia of the endometrium

Fibroid uterus
Adenomyosis
Pelvic endometriosis
IUCD inutero
Chronic tubal-ovarian mass
Tubercular endometritis (early cases)
Retroverted uterus—due to congestion
Granulosa cell tumour of the ovary

Systemic:

Liver dysfunction—failure to conjugate and thereby inactivates the estrogens.

Congestive cardiac failure.
Severe hypertension.

Endocrinal

Hypothyroidism.
Hyperthyroidism.

Haematological

Idiopathic thrombocytopenic purpura.
Leukaemia.
von Willebrand’s disease.
Platelet deficiency.

Emotional upset

Functional:

Ovular menorrhagia is quite uncommon. Two varieties are found:

• Irregular shedding of the endometrium.

• Irregular ripening of the endometrium.

due to disturbed hypothalamic-pituitary-ovarian-endometrial axis.

COMMON CAUSES OF MENORRHAGIA

Dysfunctional uterine bleeding
Fibroid uterus
Adenomyosis
polyps
use of intrauterine device(IUD)
Pregnancy complications
cancer
medications

Hormonal imbalance

In normal menstruation hormone, estrogen and progesterone regulate the endometrium lining of the uterus. due to this hormonal imbalance, endometrium shedding is affected and causes thickening of the endometrial lining and heavy bleeding occurs. usually, polycystic ovarian syndrome, obesity, thyroid problems etc hormonal imbalances happen.

Dysfunctional Uterine bleeding (DUB)

DUB is defined as a state of abnormal uterine bleeding without any clinically detectable organic, systemic, and iatrogenic cause (Pelvic pathology, e.g. tumour, inflammation or pregnancy)

The abnormal bleeding may be associated with or without ovulation and accordingly grouped into:

Ovular bleeding
Anovulatory bleeding

ovular bleeding:

Polymenorrhea or polymenorrhagia:

The condition usually occurs following childbirth and abortion, during adolescence and premenopausal period, and in pelvic inflammatory diseases

Oligomenorrhea:

Primary ovular oligomenorrhea is rare. It may be met in adolescence and preceding menopause

Anovulatory bleeding

Menorrhagia

Anovulatory bleeding is usually excessive. In the absence of growth limiting progesterone due to anovulation, endometrial growth is under the influence of estrogen throughout the cycle. There is inadequate structural stromal support and the endometrium remains fragile.

uterine fibroids

The fibroid is the commonest benign tumour of the uterus and also the commonest benign solid tumour in female.30% of cases menorrhagia is the classic symptom of symptomatic fibroid.

The menstrual loss is progressively increased with successive cycles. It is

conspicuous in submucous or interstitial fibroids. The causes are:

The increased surface area of the endometrium
Interference with normal uterine contractility due to interposition of fibroid.
Congestion and dilatation of the subjacent endometrial venous plexuses are caused by the obstruction of the tumour.
Endometrial hyperplasia due to hyperestrinism

Adenomyosis

Adenomyosis is a condition where there is ingrowth of the endometrium, both the glandular and stromal components, directly into the myometrium. 70% of the cases excessive bleeding is due to increased uterine cavity, associa_ted endometrial hyperplasia and inadequate uterine contraction.

SYMPTOMS OF MENORRHAGIA

use of one or more pads within two hours and night changes also.
Passing of large blood clots
Duration more than 7 days.
Blood loss of more than 80ml
Severe and painful menstruation
cramps
Weakness
Fatigue

HOW TO DIAGNOSE MENORRHAGIA ?

Long duration of flow, the passage of big clots, use of an increased number of thick sanitary pads, pallor, and low level of haemoglobin give an idea about the correct diagnosis and magnitude of menorrhagia.

COMPLICATIONS OF MENORRHAGIA

Anaemia:

The main complication is anaemia due to blood loss. Decreased haemoglobin level in the blood. due to anaemia, there will be pale skin, weakness, fatigue, shortness of breath etc.

Severe pain:

Due to heavy bleeding, uterine contractions become vigorous and have painful menstrual cramps(dysmenorrhea)

HOW TO FIND OUT THE CAUSE OF MENORRHAGIA ?

Sonohysterogram
Hysteroscopy
Complete blood count
Pap smear
Endometrial biopsy
Ultrasound scan
MRI

AYURVEDIC TREATMENT FOR MENORRHAGIA

Symptomatic management is done and the underlying cause of menorrhagia is treated.

Shamana Chikitsa: Stambhana medicines are given for stopping blood flow.

Pushyanuga Choornam, Usheerasavam, Ashokarishtam, Drakshadi kashaya, Shatavari Ghruta etc…

Sheetala Upachara(cooling medicines and treatment)
Sheetala Annapana(cool food and drinks)

TREATMENT

The definitive treatment is appropriate for the cause of menorrhagia.
Iron supplements to improve iron deficiency
NSAIDs for cramps and reducing bleeding.
Hormone therapy
If any surgery is needed for the cause, surgery is done.

DIET AND LIFESTYLE

High fibre-rich food recommended
Avoid hot and spicy food
Avoid coffee and alcohol
Avoid unhealthy food habits
Avoid stress
Avoid strenuous activities.
Regular exercise and meditations are done.

MENORRHAGIA – Causes, Complications & its Treatment