Irregular Excessive Uterine Bleeding

One of the most common gynecological complaints seen today is menstruation at regular cycle intervals but with excessive flow and extended duration. This syndrome is known as Menorrhagia. A normal menstrual flow occurs every 21-35 days and generally lasts between 5 to 7 days with total blood loss of about 30-44 ml (about 2-3 tablespoons).  With menorrhagia the amount of menstrual flow is about twice or more as the normal flow would be. When a woman experiences menorrhagia the signs and symptoms may include the following:

• Menstrual periods lasting longer than seven days
• Menstrual flow may include large blood clots
• Menstrual flow that soaks through one or more sanitary pads or tampons every hour for several consecutive hours
• The need to use double sanitary protection to control your menstrual flow
• The need to change sanitary protection during the night
• Heavy menstrual flow that interferes with your regular lifestyle
• Tiredness, fatigue or shortness of breath (symptoms of anemia)

Since it is difficult to measure the amount of blood loss the diagnosis is usually based upon the patient's history. So it is important for a woman who is still cycling (menstruating) to keep a diary of her monthly cycle noting the beginning and ending dates, PMS signs, clotting, amount of flow and the color of the blood. Besides history intake, a western medicine physician will also use other diagnostic methods such as blood tests (i.e. for anemia and thyroid), pap test, endometrial biopsies, and ultrasound scans to further investigate the cause of the condition. Based on the findings, further testing such as sonohysterogram, D & C, or hysteroscopy may be ordered.

In adolescents and women approaching menopause, hormone imbalance problems often cause menorrhagia along with irregular cycles. Sometimes this is called dysfunctional uterine bleeding (DUB). Other causes of abnormal bleeding include uterine fibroids and polyps. Of course, the treatment for abnormal bleeding depends on the cause.

Treatment method-
The initial method of treatment would be Drug Therapy such as nonsteroidal anti-inflammatory drugs (NSAIDs), oral contraceptives, oral progesterone, hormonal IUC (Mirena), or iron supplements (in case of anemia).
If unsuccessful with drugs, surgical treatments are a possibility: Dilation and curettage (D and C), operative hysteroscopy, endometrial ablation, endometrial resection, hysterectomy.

From the Traditional Chinese Medicine perspective, menorrhagia is a disturbance of menstruation with increased menstrual discharge and a prolonged menstrual period.  The practitioner will use TCM diagnostic methods such as pulse taking, tongue observation, "looking" (facial and body indications), and "Listening" (voice and body odor indications). A full patient history is also taken to gather more information to make the proper differentiation and diagnosis, and to create a treatment plan.  The following briefly defines how this syndrome is differentiated by looking at the condition being due to "Excess" or "Deficiency".
Excess type:
The Liver- channel is the most significant channel in women's physiology and menstruation, particularly due to its relationship with the Uterus and Blood. The Uterus stores the blood it receives from Liver. Prolonged stagnation of Liver-qi (qi=life force) may lead to too much heat in Liver-Blood which then could lead to menorrhagia. Factors such as emotional stress and diet play major roles on the regulation of Liver-qi.  In the case of excess type, blood may discharge profusely, with red and sticky vaginal blood accompanied by clots and/or excess thirst.

Deficiency types:

Spleen Channel is another significant channel in women's physiology and pathology. The Spleen makes Blood which is then stored in the Liver. Even though the Liver has a prime influence on the menstrual function, its Blood is made by the Spleen. Any deficiency of Liver-Blood in women usually indicates that the Spleen is also deficient and needs to be tonified. One of the important functions of Spleen-qi is the role of holding the organs, as well as gathering and holding Blood in place. If the qi is deficient, Blood may leak out, causing menorrhagia.  In this case the discharge is pink in color and blood is thin like water, complexion is pale, breath is short, and there is no desire to speak.

Kidney Channel is the third channel influencing the blood flow leading to menorrhagia. Kidneys' energy is referred to as the "Minister Fire" pertaining to "Heaven", producing the "Fire of gate of life".  This Fire is said to also generate Water, thus the Fire and Water within Kidneys are inseparable and interdependent.  The function of Minister Fire is to warm and nourish. The Kidney-yin is the Water and Kidney-yang is the Fire. When Kidney-yin is deficient it could cause excess Kidney-yang, or Fire. This may lead to too much heat in the blood, with profuse red uterine bleeding, dizziness, tinnitus, soreness and weakness of waist and knees, tidal fever, and flushed cheeks.
Method of Treatment in TCM depends on the differentiation and diagnosis. In the cases of "Excess" the focus of treatment would be to move Liver-qi, cool the blood and secure menstruation. In case of "Deficiency", the focus of treatment would be to tonify, strengthen and regulate Spleen-qi or Kidney-yin. Chinese herbs and acupuncture are strongly effective in treatment of menorrhagia without any invasive treatment protocol.

Soheila Beberness, L. Ac., M.S., NCCAOM Diplomat
Obstetrics and Gynecology in Chinese Medicine by Giovanni Maciocia