Heavy Menstrual Bleeding

Overview

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

SymptomsandDiagnosis

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

Treatments

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.

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 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.