Heavy Menstrual Bleeding

Overview

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 disorders, such as von Willebrand disease
  • Hormonal imbalance
  • Cervical or endometrial polyp
  • Ovarian cyst
  • Certain medications
  • Intrauterine device (IUD)

Risk Factors

Factors that may increase your chances of menorrhagia include:

  • Adolescence
  • Approaching menopause

SymptomsandDiagnosis

Symptoms

Symptoms of menorrhagia include:

  • Menstrual bleeding lasting more than 7 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

You will be asked 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
  • Removal of a sample of endometrial tissue—endometrial biopsy
  • Scraping of the inner lining of the uterus—dilation and curettage
  • Examination of the uterus and fallopian tubes—hysteroscopy

Treatments

Treatment

Treatment depends on the underlying cause of the heavy menstrual bleeding. Treatments may include:

Medications

The doctor may advise:

  • Hormonal therapy
  • An IUD that releases the hormone progesterone
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • 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
  • Removal of the lining of the uterus—endometrial ablation
  • Removal of the uterus—hysterectomy

Prevention

There are no current guidelines to prevent heavy menstrual bleeding.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

a (Menorrhagia; Hypermenorrhea)

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 Plus website. Available at:  http://www.dynamed.com/topics/dmp~AN~T361089/Abnormal-uterine-bleeding . Updated February 18, 2017. Accessed September 12, 2017.

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, 2017.