Menorrhagia is defined as prolonged bleeding (longer than 7 days) within a more or less normal interval. The flow may be severe. It is caused by anovulation with low estrogen levels or hormonal imbalance as corpus luteum insufficiency, or insufficient contraction of the myometrium and vessels.
The diagnosis is a clinical one. Treatment may be necessary if the duration of bleeding is too long or blood loss excessive. The simplest approach is to administer ergot alkaloids such as methergin or prostaglandin synthetase inhibitors. An endocrine approach is a gestagen in the second part of the cycle. Derivatives of 19-nortestosterone are more efficient than derivatives of 17α-hydroxyprogesterone or the retroprogesterone dydrogesterone (
A common approach is the administration of medroxyprogesterone acetate (MPA, 10 mg/day for 10 - 14 days). It is useful to continue progestin treatment for the following two cycles in order to prevent recurrence. Coagulation disorders associated with thrombocytopenia or clotting factor deficiencies require hematological consultation. Administration of a contraceptive pill can be a possibility, as in hypermenorrhea and metrorrhagia.
Revision date: July 9, 2011
Last revised: by Janet A. Staessen, MD, PhD