Conditions InDepth: Menstrual Disorders: Heavy Bleeding (Menorrhagia) and Absence of Menstruation (Amenorrhea)
Menstrual disorders are changes in normal menstruation (periods). Changes may be short or long term.
A normal cycle is about 28 days from the first day of bleeding to the first day of the next period. It is also normal for it to be 21 to 35 days. The rise and drop of the hormones progesterone and estrogen cause a period to happen. A rise causes the lining of the uterus to become thin. A drop causes the lining to break down and pass out of the body. This is what causes bleeding. Bleeding often lasts from 3 to 5 days. It is also normal for it to last 7 days. This cycle will happen each month from about 12 years of age to an average age of 51 years of age. The cycle normally only ends with pregnancy or menopause.
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Heavy Menstrual Bleeding
Most women lose about 2 ounces of blood or less. Menorrhagia is a loss of more blood than normal. This happens if there is a high volume of blood or a period that lasts more than 7 days. It can be caused by hormone changes or physical problems. The loss of blood can lead to anemia and other health problems.
Absence of Menstruation
Girls may not start to have their period when expected. This is called primary amenorrhea. It is found when a girl does not have a period by:
- Age 14 without growth of pubic hair and breasts
- Age 16 with or without growth of pubic hair and breasts
Periods may also stop after they have already started. Secondary amenorrhea is when it is absent for at least 3 cycles. It may be caused by:
- Pregnancy
- Hormonal imbalances
- Hypothyroidism
- High levels of prolactin in the blood
- Eating disorders
- Mental health problems
- Low or high body fat
- Rapid weight loss
- Too much exercise
- Other health problems
Amenorrhea can lead to problems like a decrease in bone density. It can cause a higher risk of osteoporosis.
Other Types of Abnormal Bleeding
- Metrorrhagia—mostly light bleeding in between periods. It may be caused by hormone changes, birth control pill, or infections. It can also be caused by a growth on cervix, uterus or a miscarriage.
- Menometrorrhagia—is bleeding in between periods, then bleeding heavily during a period. It may be caused by hormone problems.
- Hypomenorrhea—is very light periods. It is often found in female athletes. It can be caused by hormone changes from too much exercise and low weight. It can also be caused by anorexia.
- Anovulatory cycle—a specific part of the cycle does not happen. The egg is not released. It can change the cycle and how often the periods happens.
Less common problems are:
- Polymenorrhea—too many periods close together (less than 21 days)
- Oligomenorrhea—too few cycles (periods far apart)
Some causes of abnormal bleeding are:
- Problems during pregnancy
- Trauma
- Infection
- Medicines, such as intrauterine devices (IUDs) and birth control pills
- Stress
- Treatments and conditions, such as fibroids, polyps, or cancer (rare)
REFERENCES:
Abnormal uterine bleeding. EBSCO DynaMed website. Available at:https://www.dynamed.com/approach-to/abnormal-uterine-bleeding. Updated October 10, 2019. Accessed November 14, 2019.
Amenorrhea. EBSCO DynaMed website. Available at:https://www.dynamed.com/condition/amenorrhea. Updated January 16, 2018. Accessed November 14, 2019.
Bleeding Disorders in Women. US Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/ncbddd/blooddisorders/women/index.html. Updated April 25, 2018. Accessed November 14, 2019.
Klein DA, Poth MA. Amenorrhea: an approach to diagnosis and management. Am Fam Physician. 2013 Jun 1;87(11):781-788.
Last reviewed September 2019 by EBSCO Medical Review Board Elliot M. Levine, MD, FACOG Last Updated: 11/20/2020