Menorrhagia

Menorrhagia (from Greek men – month, rhegnynai – to break through) is a clinical form of abnormal uterine bleeding, in which the regular rhythm of menstrual cycles is preserved. In this case, the volume of blood loss exceeds 80 ml per cycle or the duration of bleeding is more than 7 days (according to FIGO criteria).

Etiology and pathophysiology

Pathophysiologic mechanisms of bleeding in organic uterine pathology include three main links:

1. Increased desquamation area: Pathologic processes such as myoma or adenomyosis increase the volume of the uterine cavity. Accordingly, the area of the functional endometrial layer, which is rejected during menstruation, increases.
2. Contractility disorder: The presence of submucosal or intramural nodules, as well as diffuse fibrosis in adenomyosis prevents full contraction of the myometrium. This makes it impossible to mechanically constrict the spiral arteries, which is necessary for physiologic stopping of bleeding.
3. Molecular abnormalities: There is a localized increase in fibrinolytic activity and an imbalance of vasoconstrictors (prostaglandins and endothelin) in the endometrium.

Clinical significance

Menorrhagia is a leading clinical symptom of submucosal uterine myoma, adenomyosis and systemic coagulopathies (e.g., Willebrand’s disease). Chronic blood loss is a major cause of iron deficiency anemia in women of reproductive age. This condition leads to hemic hypoxia of tissues, hair loss, tachycardia, significant reduction in work capacity and quality of life.