did you know that an average woman today experiences 300 periods as against 60 periods barely a century ago? thanks to better nutrition and healthcare, the age of menarche is down to 12-13 years and the age for menopause has increased to 45-50.

normally, this would not pose a problem, but some women experience excessive, prolonged and sometimes painful bleeding, known as menorrhagia. every year, about one in five women between 35 and 49 years, suffer from it.

menorrhagia is clinically defined as total blood loss exceeding 80 ml per cycle. it can be severely debilitating, because in addition to the general distress and inconvenience that it causes, the continual blood loss can lead to iron-deficiency and as a result, anaemia.

secondary problems also crop up. dr alka kriplani of the all india institute of medical sciences (aiims), says, “though diagnosis can be subjective, more than three or four sanitary towels a day, and periods that go on for more than seven days, indicate menorrhagia. there can be clots too.” she warns, “if the condition is left untreated, it can lead to severe consequences.”

in india, 10 per cent of all gynaecological admissions to the hospital are due to menorrhagia. of these, 24 per cent are below 20 years of age, 43 per cent are between 20 to 40 years of age, and 33 per cent are more than 40 years old. dr sheila mehra, consulting gynaecologist with moolchand and apollo hospitals, says, “thirty per cent of indian women in the reproductive age suffer from dysfunctional uterine bleeding.’’ she adds, “it is the most common gynaecological problem in the country, and the situation is getting worse. another reason could be the high prevalence of anaemia among indian women.”

what causes menorrhagia? there is no obvious explanation for the problems experienced. in some cases, it could be due to an abnormality of the uterus, or hormonal imbalance. benign (non-cancerous) uterine growths, such as fibroids or polyps, infection, or chronic illness can also cause excessive bleeding.
treat menorrhagia
the first line of treatment is usually drug therapy which dr mehra says, “is 50 per cent suitable”. it will continue till menopause and there can be side effects. drug therapy is a line adopted for those menorrhagia patients who have not completed their families, as all ablation procedures are non-reversible.

dilation and cutterage (d & c) is often used in conjunction with the drugs. it is a surgical procedure in which the uterine’s contents, including the endometrial lining, are either scraped away, or removed through vacuum aspiration. it is often carried out for diagnostic purposes, primarily to exclude the rare possibility of endometrial malignancy. d & c may reduce bleeding for a few menstrual cycles, but is usually not successful in curing menorrhagia.

hysterectopic endometrial ablation is a procedure that destroys and removes the uterine lining with an electrosurgical instrument or laser. it is performed under general anaesthesia and can take 30 to 60 minutes. it may reduce heavy bleeding to light or normal levels in some patients, and elimination of bleeding in others.

the uterine balloon ablation treatment involves the insertion of a balloon into the uterus, which is inflated and filled with hot circulating fluid. it can be used on women with irregular uterine cavities, or where fibroids are present, which means that approximately 30 per cent of patients suffering from menorrhagia cannot be treated by this method.

hysterectomy, as of now, remains the most common treatment. and, india clearly leads the way. “incidence of hysterectomy is much higher in india than in the west, though the exact figures are unknown,,” says dr mehra. according to figures available, over 700,000 hysterectomies are done annually in the united states alone, while in the uk there are nearly 100,000 hysterectomies a year.
to the rescue
the latest line of treatment is microwave endometrial ablation (mea), recently introduced in india. it uses high frequency microwave energy to cause rapid, but shallow heating to the endometrium. the microwaves are delivered by means of an applicator that is inserted into the uterus via the cervix. the procedure takes about three minutes, and can be carried out under both local and general anaesthesia. mea has been in use in the uk since 1994.

will mea be the solution to menorrhagia? dr mehra feels, “i say it is a better treatment because it has an easy curve to learn. it is computerised, so one can know how much uterine lining you are destroying. it can be done under local anaesthesia, and there is no need for fluid to distend the uterus.” a point seconded by dr kriplani.

the cost of the treatment is determined by many factors, primarily whether it is at a private or government hospital. also in a treatment like the balloon ablation, the patient has to purchase a kit costing about rs 25,000, over and above the other related treatment cost. the mea cost is still to be finalised.

the first step however, is to accept that menorrhagia is a condition that needs immediate treatment.