Menorrhagia, Heavy Menstrual Flow

CLINICAL DIAGNOSTIC MANUAL

Menorrhagia is a menstrual disorder characterised by excessive and prolonged menstrual bleeding that significantly impacts a woman’s quality of life.

This abnormally heavy flow may last for more than seven days or require the changing of tampons or sanitary pads more frequently than usual.

Menorrhagia can be a symptom of various underlying conditions, ranging from hormonal imbalances to structural uterine abnormalities and systemic disorders.

Pathology	Symptoms and Clinical Signs	Suspected Diagnosis	Confirmatory Diagnosis
Fibroids	Menorrhagia, pelvic pain, pelvic pressure, increased urinary frequency	Medical history, physical examination revealing an enlarged uterus	Pelvic ultrasound, pelvic MRI
Endometrial Carcinoma	Postmenopausal bleeding, menorrhagia, pelvic pain	History of abnormal bleeding in postmenopausal women	Endometrial biopsy, hysteroscopy
Pelvic Endometriosis	Menorrhagia, severe dysmenorrhoea, chronic pelvic pain	History of chronic pelvic pain and dysmenorrhoea	Laparoscopy
Pelvic Inflammatory Disease	Menorrhagia, chronic pelvic pain, abnormal vaginal discharge	History of recurrent pelvic infections	Pelvic ultrasound, culture of vaginal secretions
Intrauterine Device (IUD)	Menorrhagia, pelvic pain, intermenstrual bleeding	History of IUD use	Pelvic ultrasound to verify IUD position
Primary Hypothyroidism	Menorrhagia, fatigue, weight gain, dry skin	History of hypothyroidism symptoms	Thyroid profile (elevated TSH, low free T4)
Bleeding Diathesis	Menorrhagia, easy bruising, gingival bleeding	History of easy and prolonged bleeding	Coagulation tests (PT, aPTT, bleeding time)