Definition

Heavy menstrual bleeding is higher amount of blood lost during a period than expected. It is also called menorrhagia. It is normal for women to have a heavy menstrual flow at some point. This is a more severe form that happens often.

Menstrual Flow
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Causes

The cause is not always known. Excess bleeding can be caused by other health issues such as:

  • Adenomyosis—abnormal uterine tissue growth
  • Cervical or endometrial polyp
  • Uterine fibroid
  • Pelvic infections
  • Bleeding disorders, such as von Willebrand disease
  • Medicine that slows blood clotting
  • Anti-inflammatory medicine
  • Liver, kidney, or thyroid disease
  • Hormonal imbalance
  • Ovarian cyst
  • Intrauterine device (IUD)

Risk Factors

Menorrhagia is more common in:

  • Teens to early adulthood
  • Women who are close to menopause

Symptoms

Menorrhagia may be:

  • Bleeding that lasts more than 7 days
  • Very heavy bleeding (soaking through a sanitary napkin or tampon every hour)
  • Flow that needs change of sanitary napkin during the night
  • Large clots
  • Problems going through normal day because of very heavy flow

Long periods of heavy flow can also lead to fatigue and shortness of breath.

When Should I Call My Doctor?

Call your doctor if you have symptoms of menorrhagia.

Diagnosis

The doctor will ask about symptoms and past health. A physical examination, including a pelvic exam, will be done. Tests to look for possible causes may include:

Treatment

Treatment will be based on the cause. Some steps may include:

Medicine

Medicine may help to stop or ease heavy flow, such as:

  • Hormonal therapy
  • An IUD that releases the hormone progesterone

Other medicine may help to ease symptoms of a heavy flow, such as:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Iron supplement

Surgical Procedures

Surgery may be needed if the bleeding is severe and not responding to other treatment. Surgery choices include:

  • Dilation and curettage
  • Operative hysteroscopy—may be used along with other tools to remove a polyp
  • Removal of the lining of the uterus—endometrial ablation
  • Removal of the uterus—hysterectomy

Prevention

There are no steps to prevent heavy menstrual bleeding.

RESOURCES:

The American Congress of Obstetricians and Gynecologists
http://www.acog.org

Women's Health—US Department of Health and Human Services
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:

Abnormal uterine bleeding. EBSCO DynaMed website. Available at:https://www.dynamed.com/approach-to/abnormal-uterine-bleeding. Accessed September 12, 2020.

Apgar B, Kaufman A, et al. Treatment of menorrhagia. Am Fam Physician. 2007;75(12):1813-1819.

11/20/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: FDA approves Lysteda to treat heavy menstrual bleeding. United States Food and Drug Administration website. Available at:http://www.dynamed.com/topics/dmp~AN~T361089/Abnormal-uterine-bleeding. Accessed September 12, 2019.

Last reviewed September 2020 by EBSCO Medical Review Board Chelsea Skucek, MSN, BS, RNC-NIC  Last Updated: 8/7/2020