Heavy Menstrual Bleeding

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:

• 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:

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.