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

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.

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:

• 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

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

Prevention

There are no steps to prevent heavy menstrual bleeding.