Heavy Menstrual Bleeding
(Menorrhagia; Hypermenorrhea)
Definition
Heavy menstrual bleeding (also called menorrhagia) is excessive and/or prolonged menstrual bleeding at regular intervals. Although about 30% of women have heavy periods, only 10% of women have menorrhagia. On average, menstrual flow occurs every 28 days and lasts for five days. Four tablespoons to one cup (60-250 milliliters) of blood is lost during this time.
Menstrual Flow
Causes
In some cases, the cause of menorrhagia is unknown. However, many conditions have been known to be associated with menorrhagia, such as:
- Adenomyosis—when tissue that normally only lines the uterus, also grows into the muscular walls of the uterus
- Cervical or endometrial polyps
- Uterine fibroids
- Infection (pelvic infections)
- Blood-clotting disorders
- Anticoagulant medicine (blood thinners)
- Anti-inflammatory medicine (taking large amounts over a long period of time)
- Liver, kidney, or thyroid disease
- Problems with an intrauterine device (IUD)
- Ovarian cysts
- Chronic condition
Risk Factors
Those at greatest risk for menorrhagia include females who:
Symptoms
Symptoms of menorrhagia include:
- Menstrual bleeding lasting more than seven days
- Unusually heavy bleeding (soaking through a sanitary napkin or tampon every hour)
- Menstrual flow requiring change of sanitary protection during the night
- Menstrual flow including large clots
- Menstrual flow interfering with lifestyle
- Fatigue and/or shortness of breath (symptoms of anemia)
Diagnosis
Your doctor will ask about your symptoms and medical history. A physical examination, including a pelvic exam, will be done as part of the evaluation. Tests may include:
- Pap test
- Blood tests
- Pregnancy test
- Ultrasound—a test that uses sound waves to examine your reproductive organs (uterus and ovaries)
- Endometrial biopsy—removal of a sample of endometrial tissue to look for changes in the lining of the uterus
- Dilation and curettage (D&C)—scraping of the inner lining of the uterus
- Hysteroscopy—examination of the cervix and fallopian tubes using a telescope-like viewing device
Treatment
Treatment of menorrhagia will depend on the underlying cause. Women who experience persistent excessive bleeding should discuss with their doctor whether to take iron supplements to prevent anemia.
If there is no condition causing your menorrhagia, your doctor may prescribe the following:
Medications
These may include:
- Hormone therapy (estrogen and/or progestogen hormones by mouth, skin application, vaginal application, or injection)
- An IUD that releases a progestogenic drug (eg, Mirena)
- Nonsteroidal anti-inflammatory drugs, such as ibuprofen (eg, Advil), naproxen (eg, Aleve), and mefenamic acid (eg, Ponstel)
- Medicine to enhance blood clotting (eg, tranexamic acid [Lysteda])
Surgical Procedures
Procedures may include:
- Dilation and curettage (D&C)
- Operative hysteroscopy—A long, thin instrument is inserted into the uterus that can aid in removal of a polyp or fibroid.
- Endometrial ablation or resection—The surgical removal of the lining of the uterus using heat, microwave, or surgical tools. After this procedure, you will not be able to carry a pregnancy.
- Hysterectomy—The surgical removal of the uterus. After this procedure, you will not be able to carry a pregnancy. If the ovaries are also removed, early menopause will follow.
Your age, overall health, and medical history should be considered when choosing treatment. Discuss with your doctor your plans for having children.
Prevention
For most women there are no specific steps for prevention. However, if your menorrhagia is caused by a medicine, you may prevent the condition by discontinuing use of this medicine if your doctor instructs you to do so.
The American Congress of Obstetricians and Gynecologists
The National Women’s Health Information Center
The Canadian Women's Health Network
The Society of Obstetricians and Gynaecologists of Canada
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Fritz M, Speroff L. Clinical Gynecologic Endocrinology and Infertility 8th ed. Baltimore, MD: Lippincott, Williams, and Wlkins; 2011.
Harvard Guide to Women’s Health. Harvard University Press; 1996.
Mayo Foundation for Medical Education and Research website. Available at: http://www.mayo.edu/. Accessed October 13, 2005.
Menstrual cycle problems. Family Doctor.org. Available at: http://familydoctor.org/familydoctor/en/health-tools/search-by-symptom/menstrual-cycle-problems.html. Accessed March 8, 2012.
United States National Library of Medicine, National Institutes of Health website. Available at: http://www.nlm.nih.gov/. Accessed October 13, 2005.
University of Utah Health Sciences Center. Available at: http://www.med.utah.edu/healthinfo/adult/women/menor.htm. . Accessed October 13, 2005.
11/20/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: FDA approves Lysteda to treat heavy menstrual bleeding. United States Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm190551.htm. Published November 13, 2009. Accessed November 20, 2009.
Last reviewed December 2011 by Ganson Purcell Jr., MD, FACOG, FACPE
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
