Heavy Menstrual Bleeding



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



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.


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


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


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.