Heavy menstrual bleeding and homoeopathic management

Menorrhagia is a symptom denoting excessively heavy menstrual bleed ing. It is a complaint that is difficult to verify objectively in many cases, even with a detailed case history. Issues of perception and tolerance of symptoms are important in whether a patient presents to a doctor, and this varies considerably from one society to another. Research studies indicate tha t the upper limit of normal blood loss is between 60 and 80 ml/month. Above this level women tend to become progressively iron deficient. Hence, any development which may help the precision of this assessment is valuable, and several of these will be discussed. Causes of menorrhagia can be div ided into three groups: (1) pelvic diseases, such as myomata and adenomyosis; (2) systemic disorders, such a s coagulopathies and hypothyroidism; and (3) dysfunctional uterine bleeding —a diagnosis of exclusion. Investigations are mainly aimed at improving the precision of the underlying diagnosis, de fining the severity of the condition and excluding anaemia. Hence, the most important investig ations are a full blood count, a diagnostic hysteroscopy and endometrial sampling. In clinical practice, other specific investigations need only be carried out if there are unusual features in the history or examination, or if previous treatments have failed. In a research situation there have been numerous studies aimed at elucidation of the mechanisms of heavy bleeding and some of these will be reviewed.

myomata, adenomyosis, coagulopathies, hypothyroidism, dysfunctional uterine bleeding

Menorrhagia is defined as heavy but regular menstrual bleeding. Idiopathic ovulatory menorrhagia is regular heavy bleeding in the absence of recognisable p elvic pathology or a general bleeding disorder. Objective menorrhagia is taken to be a total men strual blood loss of 80 mL or more in each menstruation. Subjectively, menorrhagia m ay be defined as a complaint of regular excessive menstrual blood loss occurring over several consecutive cycles in a woman of reproductive age. Incidence/Prevalence In the UK, 5% of women aged 30-49 years consult their general pr actitioners each year with menorrhagia. In New Zealand, 2-4% of primary-care consultations by pr emenopausal women are for menstrual problems. Aetiology/Risk factors Idiopathic ovulatory menorrhagia is thought to be caused by disordered prostaglandin production within the endometrium. Prostaglandins may also be implica ted in menorrhagia associated with uterine fibroids, adenomyosis, or the presence of an IUD. Fibroids have been reported in 10% of women with menorrhagia (80-100 mL/cycle), and i n 40% of women with severe menorrhagia (at least 200 mL/cycle). Prognosis Menorrhagia limits normal activities and causes iron-deficiency anaemia in t wo thirds of women proven to have objective menorrhagia. One in five women in the UK and one in three in the USA have a hysterectomy before the age of 60 years; meno rrhagia is the main presenting problem in at least half of these women. About half of wom en who have a hysterectomy for menorrhagia are found to have an anatomically normal uterus. International Journal of Homoeopathic Sciences http://www.homoeopathicjournal.com ~ 299 ~ Aims of intervention To reduce menstrual bleeding; improve quality of life; and prevent or correct iron-deficiency anaemia, with minimum adverse effects. Women may regard amenorrhea as a benefit or a harm of treatment, depending on their perspective. Outcomes Menstrual blood flow (assessed objectively [mL/cycle] or subjectively); haemoglobin concentration; quality of life; patient satisfaction; incidence of adverse drug effects; and incidence of postoperative complications. Whether a particular percentage reduction in menstrual blood loss is considered clinically important will depend on pre-treatment menstrual loss and on individual women's perceptions of acceptable menstrual loss. Disclaimer The information contained in this publication is intended for medical professionals. Categories presented in Clinical Evidence indicate a judgement about the strength of the evidence available to our contributors prior to publication and the relevant importance of benefit and harms. We rely on our contributors to confirm the accuracy of the information presented and to adhere to describe accepted practices. Readers should be aware that professionals in the field may have different opinions. Because of this and regular advances in medical research we strongly recommend that readers' independently verify specified treatments and drugs including manufacturers' guidance. Also, the categories do not indicate whether a particular treatment is generally appropriate or whether it is suitable for a particular individual. Ultimately it is the readers' responsibility to make their own professional judgements, so to appropriately advise and treat their patients. To the fullest extent permitted by law, BMJ Publishing Group Limited and its editors are not responsible for any losses, injury or damage caused to any person or property (including under contract, by negligence, products liability or otherwise) whether they be direct or indirect, special, incidental or consequential, resulting from the application of the information in this publication. Homeopathic approach Bovista Premenstrual problems with puffiness in the extremities, fluid retention, and a bloated feeling often indicate a need for this remedy. The woman may feel very awkward and clumsy, and may constantly be dropping things because of swollen-feeling hands. Diarrhea occurring around the time of the menstrual period strongly indicates this remedy. Calcarea carbonica PMS with fatigue, anxiety, and a feeling of being overwhelmed suggest a need for this remedy. The woman may have problems with water-retention and weight gain, tender breasts, digestive upsets, and headaches. Periods often come too early and last too long, sometimes with a flow of bright red blood. A general feeling of chilliness, with clammy hands and feet, and cravings for sweets and eggs are other indications for Calcarea. Lachesis Women who need this remedy are usually intense, with a tremendous need for an outlet, both physically and mentally. Symptoms of PMS include congestion, headaches, flushing, surges of heat, and an intense outspoken irritability —often with strong feelings of suspicion or jealousy. When the flow arrives, it may be heavy, but brings relief of tension. Intolerance of restrictive clothing around the waist or neck is another indication for Lachesis. Lycopodium PMS with a craving for sweets and a ravenous appetite (sometimes a bulimic tendency) suggests a need for this remedy. Digestive upsets with abdominal bloating and flatulence are often seen, with the person feeling worst in the late afternoon and evening. Menstrual periods may be delayed, followed by a heavy flow that goes on for extra days. A woman who needs this remedy often wears a worried look and lacks self-confidence —although she may be irritable and bossy to pets and family members. A desire to be alone, but with someone in the other room, is another indication for Lycopodium. Natrummuriaticum A person who needs this remedy usually seems reserved to others, but is deeply emotional inside. She may feel extremely sad and lonely, but gets affronted or angry if others try to console her or sympathize. Depression, anger over minor things, and a need to be alone to cry are often seen when Natrummur is needed. Menstrual problems can be accompanied by migraines, or a backache that feels better from lying on something hard or pushing a solid object against the painful place. A craving for salt, strong thirst, and a tendency to feel worse from being in the sun are other indications for this remedy. Nux vomica When a woman with PMS is extremely impatient, pushy, and intolerant, this remedy may be of use. Uncomfortable, irregular menstrual periods can be experienced, often with a nagging urge to move the bowels before the flow begins. Constipation is common, and constricting pains may extend to the rectum or tailbone region. Anger, mental strain, physical exertion, and overindulgence in coffee, alcohol, or food can aggravate the problems. The woman often feels chilly and improves from warmth and rest.

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