Menometrorrhagia

Menometrorrhagia refers to abnormal uterine bleeding characterized by heavy or prolonged menstrual bleeding accompanied by irregular or frequent intervals. It is often described as a combination of menorrhagia (heavy bleeding during menses) and metrorrhagia (bleeding at irregular times). The condition can occur at any reproductive age and may be episodic or persistent.

The causes are varied and can be broadly categorized as hormonal, structural, coagulative, or related to pregnancy or medications. Hormonal factors include anovulatory cycles with estrogen-driven endometrial proliferation and insufficient progesterone. Structural causes encompass uterine fibroids, polyps, adenomyosis, and endometrial hyperplasia. Coagulation disorders such as von Willebrand disease or platelet function disorders, as well as anticoagulant use, can contribute. Pregnancy-related bleeding, thyroid disease, prolactin abnormalities, and certain medications may also be involved.

Evaluation typically begins with a detailed history and physical examination, followed by pregnancy testing. Laboratory tests may include complete blood count, iron studies, thyroid function, and coagulation testing when indicated. Imaging with pelvic ultrasound is commonly used to assess structural causes. Endometrial sampling or biopsy is considered in women over 45 or with risk factors for endometrial pathology. In selected cases, hysteroscopy or MRI may be indicated.

Management is guided by the underlying cause and the severity of bleeding. Acute heavy bleeding may require stabilization and hemostatic measures such as tranexamic acid or NSAIDs. Long-term management may involve hormonal therapies (combined oral contraceptives, progestins, or a levonorgestrel-releasing intrauterine system), GnRH agonists for reversible control of bleeding, iron supplementation for anemia, and treatment of coexisting conditions. Refractory cases may require surgical options, including endometrial ablation or hysterectomy, depending on fertility desires.