What Is Menorrhagia (Heavy Menstrual Bleeding)?

Menorrhagia is a common physical condition that causes an abnormally heavy period bleeding and can last for an extended amount of time. It affects 1 in every 20 females. Although excessive menstrual bleeding is common, it is important to consult with a doctor if you are experiencing symptoms due to a risk of developing anemia, as well as it being a disruption to your day to day functioning.

Many women with heavy periods struggle to enjoy daily activities and can experience disrupted sleep. A woman does not need to be limited by an abnormally heavy period as there are several effective treatments for menorrhagia. If you are experiencing heavy period bleeding with cramping, that lasts an unusually long time, please consult with a doctor to discuss treatment options.

Symptoms

It is common for women to have occasional heavy periods and cramping. However, people with menorrhagia exhibit consistent heavy bleeding and cramping that is severe enough to impact daily level of functioning. Symptoms of menorrhagia include:

• Soaking through a tampon or sanitary napkin within an hour for several consecutive hours
• Having to wake up in the middle of the night to change a sanitary napkin or tampon
• Having to wear double protection (the use of a tampon and sanitary napkin) to control menstrual flow
• Passing blood clots bigger than a quarter
• Bleeding for longer than a week
• Symptoms of anemia, such as fatigue, muscle weakness, dizziness, shortness of breath
• Loss of daily functioning (restricting certain activities due to heavy menstrual flow)

What Are the Causes of Menorrhagia?

Sometimes the cause of menorrhagia is unknown. However, there are a number of conditions that can lead to the development of menorrhagia. Those conditions and causes include: 

• Hormone imbalance. The buildup of the lining of the uterus is regulated by balanced hormones (estrogen and progesterone). If a hormone imbalance occurs during the menstrual cycle, it can cause the endometrium to build up in excess, which can lead to heavy menstruation.  
• Dysfunction of the ovaries. If the ovaries do not release an egg during the menstrual cycle, the progesterone hormone cannot be produced, which can create a hormone imbalance and lead to menorrhagia. 
• Polyps. Small benign growths on the uterine lining, which can cause heavy or prolonged menstrual bleeding.
• Uterine fibroids. The noncancerous tumors in the uterus, which can develop during childbearing years, may cause heavy or prolonged menstrual bleeding.
• Adenomyosis. A condition that occurs when glands from the endometrium become lodged in the uterine muscle, usually causing heavy bleeding and cramping.
• Intrauterine device (IUD). Menorrhagia is a common side effect of using an IUD. A healthcare professional can help you come up with an alternate form of birth control, if necessary. 
• Complications in pregnancy. Complications such as a miscarriage or an abnormal location of the placenta may lead to symptoms of menorrhagia.
• Cancer. Cervical or uterine cancer can cause abnormal or heavy bleeding, especially if you are postmenopausal or had an irregular pap test in the past.
• Genetics. Some bleeding disorders can cause excessive bleeding, such as von Willebrand’s disease. The bleeding can be excessive due to a missing blood clotting property. 
• Medications. Certain medications, such as anti-inflammatories, hormonal medications, and anticoagulants can cause heavy or prolonged bleeding. 
• Other medical conditions. Some medical conditions may be linked to heavier or prolonged bleeding, such as liver or kidney disease, or thyroid issues.

Diagnosis

Menorrhagia is diagnosed after a medical professional takes a thorough history of a patient’s menstrual cycle and conducts a physical exam and other tests. Sometimes a doctor will have a patient keep a log of the menstrual cycle’s frequency, duration, and severity of bleeding and cramping. After a physical examination, other diagnostic measures that may be utilized include:

• Blood tests: These tests can detect any abnormalities in the blood, such as anemia, thyroid issues, or issues with clotting.
• Pap test: Cells from the cervix are tested to check for cancer, issues that could lead to cancer, infection, or inflammation.
• Ultrasound: An imaging method that allows for pictures of the uterus, pelvis and ovaries.
• Endometrial biopsy: A sample of tissue is taken from the uterus to be looked at by a pathologist.

Additional testing may be recommended after initial findings. These tests might include:

• Hysteroscopy. A thin viewing instrument with a light on the end of it is inserted into the uterus in order to detect any signs of polyps, fibroids, or any other problems in the uterus. 

• Sonohysterography. This procedure involves injecting fluid through a tube and into the uterus, which allows a doctor to view any issues in the uterus by using ultrasound.
• Dilation and curettage (D&C). The procedure involves scraping and examining the lining of the uterus while the patient is under sedation. The scraping in this procedure can help treat the cause of bleeding.

Treatment

There are several forms of treatment for menorrhagia. A patient’s medical history, overall health, severity of the condition, plans for childbearing, tolerance to medications and procedures, effect on lifestyle, and personal preference will determine what form what form of menorrhagia treatment will be used. The following lists provide examples of effective treatment options:

Medications

Treatment for menorrhagia depends on the cause and severity of the bleeding as well as age, health and medical history. 

Treatments for hormone issues include:

• Birth control. Oral contraceptives help to reduce menstrual flow and prolonged bleeding.
• Hormonal IUD. Hormonal intrauterine devices release progestin which helps to thin out the uterine lining, which reduces heavy menstrual flow and cramping 
• Progesterone. Hormone treatment that reduces symptoms of menorrhagia.
• NSAIDS. Anti-inflammatory medication that helps to decrease cramping and menstrual flow.

Treatments that work specifically with the uterine lining include:

• Resection. This is a procedure that removes the lining of the uterus.
• Ablation. In this procedure, the lining of the uterus (endometrium) is destroyed.
• Uterine artery embolization. A procedure that seeks to shrink any fibroids in the uterus by cutting off their blood supply.
• Focused ultrasound surgery. Uses ultrasound waves to destroy fibroid tissue and reduce excessive menstrual flow.
• Myomectomy. The procedure involves the surgical removal of fibroids.
• Hysteroscopy. A procedure that removes any polyps, fibroids, and the lining of the uterus.
• Dilation and curettage (D&C). The procedure scrapes or suctions tissue out from the lining of the uterus, and helps to reduce menstrual bleeding.
• Hysterectomy. Surgery to remove your cervix and uterus that will permanently stop menstrual periods and cause sterility.
• Iron supplements. Used to put iron back into the blood due to excessive blood loss through heavy or prolonged periods.

Treatments to stop or slow the bleeding include:

• Desmopressin. A nasal spray that helps to stop bleeding caused by certain bleeding disorders.
• Antifibrinolytic medications. Helps to reduce bleeding.
• Tranexamic acid. Helps to decrease menstrual blood loss and only needs to be taken during the time of bleeding.

Procedures

• Dilation and curettage: The cervix is dilated and tissue from the lining of the uterus is scraped or suctioned off to help reduce period blood flow.
• Uterine artery embolization: The uterine arteries are blocked and blood supply to the arteries is stopped in order to shrink any fibroids. The procedure guides a catheter through an artery in the thigh to the uterine arteries, and injects a substance into the blood vessels to reduce blood flow to the fibroids.
• Focused ultrasound surgery: Uses ultrasound waves to shrink fibroids by destroying the tissue, which helps to reduce period blood flow.
• Myomectomy: A surgical removal of the fibroids, which can be done through open abdominal surgery, laparoscopically (several small incisions), or hysteroscopically (through the vagina and cervix).
• Endometrial ablation: Uses a laser, radiofrequency, or heat to destroy the lining of the uterus. Typically, women have lighter periods after this procedure. However, this type of procedure can create complications in future pregnancies and it is recommended to stay on a reliable contraceptive until menopause.
• Endometrial resection: Uses a wire loop to remove the lining of the uterus. Pregnancy is not recommended after this procedure.
• Hysterectomy:  A surgery that removes the uterus and cervix. This procedure is permanent, causing sterility and ending menstrual periods. This surgery is performed under anesthesia and requires hospitalization.

Most of the surgical procedures are performed on an outpatient basis. Although some require anesthetics, a patient can usually go home later that same day. A hysterectomy and abdominal myomectomy do require a longer hospitalization.

When to See the Doctor

It is important to contact your healthcare provider if you are experiencing the following symptoms:

• Menstrual flow that is excessive and heavy enough to soak through at least one sanitary napkin or tampon an hour for consecutive hours
• Irregular vaginal bleeding or bleeding between periods
• Vaginal bleeding after menopause

If you are experiencing symptoms of menorrhagia, contact your Baptist Health gynecologist to determine diagnosis and discuss treatment options.