Heavy Menstrual Bleeding
(Menorrhagia; Hypermenorrhea)
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.
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Causes TOP
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 TOP
Menorrhagia is more common in:
- Teens to early adulthood
- Women who are close to menopause
Symptoms TOP
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 TOP
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:
- Pap test
- Blood tests
- Transvaginal ultrasound
- Removal of a sample of endometrial tissue— endometrial biopsy
- Scraping of the inner lining of the uterus— dilation and curettage
- Test to closely view the uterus and fallopian tubes— hysteroscopy
Treatment TOP
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
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
...(Click grey area to select URL)
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: 08/07/2020