Menorrhagia may be defined as a heavy menstrual bleeding over several cycle. The traditional, objective, definition of menorrhagia is of menstrual blood loss of 80 mL or more per cycle. Measured blood loss has been shown to have little correlation with women’s own perceptions of bleeding heaviness and so the clinical definition typically used is that of excessively heavy bleeding for an individual.
In practice, any blood loss that is perceived by a women to be excessive or as having a negative impact on her quality of life warrants counseling and possibly treatment.
Causes of menorrhagia
- Blood dyscresia leukemia
- Coagulopathy thrombocytopenic Purpura, severe anemia
- Thyroid dysfunctions, both hypo and hyperthyroidism
- Early stage of genial tuberculosis
- Pelvic inflammatory disease
- Pelvic adhesions
- Feminisisng ovarian tumor such as theca cells and granulose cell tumor
- Poststerlisation menorrhagia
- Progestogen – only pills
Hormonal or dysfunctional
- Irregular shedding of endometrium, irregular ripening of endometrium
- Anovulatory cycles (oestrogen withdrawl)
- Metropathia haemorrhagica
Investigations in case of menorrhagia
A hemoglobin estimation is best accompanied by a serum ferritin level to reflect the iron stores.
Pelvic ultrasound may be particularly useful in specific situation and may provide information to support a specific diagnosis. ultrasound examination is less satisfactory at identifying areas of endometriosis or inflammation accompanied by anatomical distortion from complications.
Sampling the endometrium in the surgery can be a useful procedure if a positive result is obtained. If it is negative then a further procedure is indicated. Endometrial sampling via the hysteroscope remains the gold slandered to check the endometrial pathology. A dilatation and curettage is a diagnostic and not a therapeutic test, and should be accompanied by a hysteroscopy.
Indications of dilatation and curettage and hysteroscopy in women with menorrhagia
- Women over 40 years of age
- Under 40 years with persistent IMB
- Under 40 years with failed medical treatment
- Abnormal endometrial sample
- Abnormality suggested on transvaginal ultrasound
Homeopathic treatment of menorrhagia
Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat menorrhagia but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to treat menorrhagia that can be selected on the basis of cause, sensations and modalities of the complaints. For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following remedies which are helpful in the treatment of menorrhagia:
Menorrhagia due to endocrinal dysfunction is well treated by this remedy, especially of the thyroid gland; the synthesis of thyroxin is hampered in these patients; menstruation is irregular; Generally it is uterine haemorrhage; menorrhagia with enlarged and indurated uterus; Iodum may be thought of when haemorrhage is due to pathological condition of uterus; there is acute catarrh of endometrium; great weakness during menses, wedge like pain in right ovarian region; haemorrhage occurring at every stool with cutting pain in the abdomen, pain in the loins and small of back.
Patient shows signs of rapid metabolism. loss of flesh with great appetite . majority of glands of the body are hypertrophied, hard and nodular. patient is emaciated. hot patient, better by cold; patient wants to move all the time as the symptoms are relieved when she is busy; patient is always hungry and wants to eat all the time. but also has indigestion with diarrhoea. Assimilation is poor and very low. liver and spleen are enlarged; incontinence of urine; cough with difficulty in breathing; catarrhal condition of the nose; watery discharge with sneezing.
Patient is weak minded and forgetful; impulsive, insanity; sadness with melancholic mood; excitable, restlessness and very anxious patient has the impulse of doing something in a hurry; < Warmth in general, exertion; > eating, cold in general, by walking or by movement.
Pelvic inflammatory diseases such as salpingo-oophoritis, chronic endometritis usually tubercular in origin or malignancy of genito-urinary tract is well treated by this remedy. dysfunctional uterine haemorrhage is an important cause of menorrhagia; polycystic ovarian disease may be seen developed if the patient has sycosis as predominant miasm; menses too early and scanty but last too long; stitching pains; women, burning and stitching pain in the region of uterus; ovaries are inflamed and painful at the time of menses; these pains are radiating down the inner side of the thighs; fibroids of the uterus are common; menorrhagia due to uterine polypi.
There is numbness, trembling and paralytic weakness of the extremities; major joints of the body are inflamed and stiff; stitching pains in the breast during menses; laryngitis with hoarseness of voice; bronchitis with bloody expectoration; sharp and stitching pain in chest with haemoptysis; left side of the chest is usually affected; haemorrhoids with burning pain; morning diarrhoea, stools are profuse watery and involuntarily poured with a sensation as if anus is wide open.
Mentally patient is excitable and has violent imaginations which prevent the sleep; patient is hypersensitive to external impressions, great debility and prostration, weak memory; anxiety, irritability and fear mark the remedy; stupor, dizziness, sluggishness and delirious condition of the patient; brain fag from mental exertion.
It is a great anti haemorrhagic remedy; Sabina acts upon the mucous membrane of the uterus and also upon the serous membranes; pain flies from sacrum to pubis. haemorrhage is profuse at the time of menses; they are longlasting, partly fluid and partly clotted, offensive in nature; blood comes in gushes; intense colicky pains in abdomen at the time of menses, these pains are associated with bearing down or labor like pains; pain traverse from vagina to uterus; discharge of blood between periods with sexual excitement; inflammation of the tubes, ovaries and uterus; uterine fibroids are usually the cause of menorrhagia at the climacteric age; profuse leucorrhoea and the discharge is bloody.
Sabina patient has haemorrhagic tendency and bleeds from all the mucous membranes; pulsation all over the body with sense of fullness. shooting type of pains from sacrum to pubes; sense of fullness in the rectum with bleeding haemorrhoids and the blood is bright red. Warts around the anus, pus like gonorrhoeal discharge from urethra; urethra is inflamed.
Patient is nervous sad and depressed. music makes her nervous; also music is intolerable for her.
Menorrhagia due to prolapse of uterus; menses are profuse and too early, sometimes twice a month; blood is dark coagulated; there is bearing down and pressing pains in the uterine region; this pain traverse from hip to hip. severe pains in lower extremities; backache after menstruation, with heavy pressing down sensation; if the menses are suppressed, they are scanty or copious with severe pains during the flow; all the symptoms either physical or mental are worse during menses; discharges are offensive; spasms and cramps in the muscles of back. shooting and throbbing pains in head as a reflux of uterine bleeding; nausea and vomiting caused by pressure on the spine; ovarian neuralgia is well treated by this remedy; pain across the pelvis; rheumatic pains in the joints; sleeplessness.
Patient is depressed; visions of rat, mice running across the room; delirium, hysterical and epileptic spasms; the mental symptoms are intermingled with rheumatism. mental symptoms are worse during menses; Sabina patient is so much depresses that, she cries when questioned; sensation as if some weight is laid on her head; almost all the symptoms are due to fear and she is worse during menstrual flow.
Chronic menorrhagia with thin, corrosive and burning leucorrhoea.
Bright red, hot flow with head symptoms.
Profuse, black, membranous, clotted blood, too early, with labor like pains from back to pubes.
Menorrhagia from ulcerated os and cervix, blood dark and offensive and continuing a long time, <on lifting a weight or from exertion; flow too profuse, from atony of uterus, passive <from slightest motion, dark colored, coagulated, of bad odor; face pale, of earthy colour, feeble from loss of blood, extreme mental depression and irritability; profuse urination, burning pains in back, frequent palpitation of heart.
Menorrhagia in women with chapped skin and rhagades on hands and feet; uterine ulcers, with bloody suppuration, smelling like old cheese, edges of ulcer sensitive; every slight injury causes ulceration.
Menorrhagia with sighing and sobbing, faint feeling at the pit of the stomach; great despondency, she seems full of suppressed grief; menstrual blood black, in clots; of putrid odor.
Blood flows from least exertion, menses every two weeks; this and such remedies as Millefolium, Ferrum, carbo-veg, erigeron will meet most cases of metrorrhagia and menorrhagia.