Heavy Menstrual Bleeding
(Menorrhagia; Hypermenorrhea)
Definition
Heavy menstrual bleeding (also called menorrhagia) is excessive menstrual blood loss that interferes with a woman's quality of life.
Menstrual Flow
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Causes
In some cases, the cause is not known. However, many conditions have been associated with menorrhagia, such as:
- Uterine fibroid
- Bleeding disorder (eg, von Willebrand disease)
- Hormonal imbalance
- Cervical or endometrial polyp
- Ovarian cyst
- Certain medicines
- Intrauterine device (IUD)
Risk Factors
Factors that may increase the risk of menorrhagia include:
- Being an adolescent
- Approaching menopause
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)
When Should I Call My Doctor?
Call your doctor if you have symptoms of menorrhagia.
Diagnosis
Your doctor will ask about your symptoms and medical history. A physical examination, including a pelvic exam, will be done. Tests may include:
- Pap test
- Blood tests
- Transvaginal ultrasound
- Endometrial biopsy (removal of a sample of endometrial tissue)
- Dilation and curettage (scraping of the inner lining of the uterus)
- Hysteroscopy (examination of the cervix and fallopian tubes)
Treatment
Treatment depends on the underlying cause of the heavy menstrual bleeding. Your doctor will work with you to create a treatment plan.
Medications
Your doctor may recommend:
- Hormonal therapy
- An IUD that releases the hormone progesterone
- Nonsteroidal anti-inflammatory drugs
- Iron supplement
Surgical Procedures
In some cases, surgery may be needed, such as:
- Dilation and curettage
- Operative hysteroscopy (may be used along with other tools to remove a polyp)
- Endometrial ablation (removal of the lining of the uterus)—This procedure reduces your chance of becoming pregnant.
- Hysterectomy (removal of the uterus)—After this procedure, you will not be able to become pregnant.
RESOURCES:
The American Congress of Obstetricians and Gynecologists
http://www.acog.org/
The National Women’s Health Information Center
http://www.womenshealth.gov/
CANADIAN RESOURCES:
The Canadian Women's Health Network
http://www.cwhn.ca/
The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org/
REFERENCES:
Apgar B, Kaufman A, George-Nwogu U, Kittendorf A. Treatment of menorrhagia. American Academy of Family Physicians website. Available at: http://www.aafp.org/afp/2007/0615/p1813.html . Published June 15, 2007. Accessed August 14, 2012.
Heavy menstrual bleeding. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated May 25, 2012. Accessed August 14, 2012.
Menorrhagia (heavy menstrual bleeding). Mayo Clinic website. Available at: http://www.mayoclinic.com/health/menorrhagia/DS00394 . Updated June 25, 2011. Accessed August 14, 2012.
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... . Published November 13, 2009. Accessed November 20, 2009.
Last reviewed September 2012 by Andrea Chisholm
Last Updated: 09/27/2012