Menorrhagia (Heavy Menstrual Bleeding): Causes and Treatments


Menorrhagia, otherwise known as heavy menstrual periods, is described as heavy and prolonged menstrual bleeding which disrupts a woman’s normal activities and affects more than 10 million women in the United States annually.1,2

Menorrhagia is one of the most common gynecologic complaints in contemporary gynecology and symptoms related by a patient with menorrhagia often can be more revealing than laboratory tests.

You will also see introductions at the end of some sections to any recent developments that have been covered by MNT‘s news stories. Also look out for links to information about related conditions.

Fast facts on menorrhagia

Here are some key points about menorrhagia. More detail and supporting information is in the main article.1,2

  • Menorrhagia is a severe form of menstrual bleeding which affects more than 10 million women in the US annually.
  • Menorrhagia is the concern most commonly reported to health care providers.
  • Menorrhagia can causeanemiain which a woman will exhibit symptoms such astiredness, fatigue and shortness of breath due to the heavy bleeding.
  • Menorrhagia affects a woman’s ability to perform her normal daily activities.
  • Complications of menorrhagia include iron deficiency anemia and severe pain.

What is menorrhagia?

The type of heavy menstrual flow in those with menorrhagia generally has a duration of more than 7 days and the bleeding requires a woman to change her pad or tampon every 2 hours or less.1,2

In addition, a woman with menorrhagia may also pass blood clots larger than a quarter and experience anemia due to the volume of blood loss. This is a severe form of heavy menstrual bleeding and often requires medical attention to treat the disorder.

What causes menorrhagia?

While menorrhagia is the most commonly reported concern expressed to health care providers, in half of the women diagnosed, an underlying cause cannot be identified. Despite this finding, there are some conditions, which may cause menorrhagia and include:1,2

  • Hormonal disturbances
  • Ovarian dysfunction
  • Uterinefibroids
  • Uterine polyps
  • Adenomyosis
  • Non-hormonal Intrauterine Device (IUD)
  • Pregnancy-related complications such as a miscarriage or an ectopic pregnancy can cause menorrhagia
  • Cancersuch as uterine, cervical or ovarian cancers
  • Inherited bleeding disorders such as Von Willebrand’s disease or a platelet function disorder
  • Medications, such as anti-inflammatory and anticoagulants
  • Other health conditions such aspelvic inflammatory disease (PID), thyroid disorders,endometriosis, and liver or kidney disease.

Signs and symptoms of menorrhagia

There are several signs and symptoms of menorrhagia and may include the following:1,2

  • Heavy vaginal bleeding resulting in the saturation of one or more sanitary pads or tampons every hour for several hours
  • Heavy bleeding requiring the use of double sanitary protection
  • Having to change pads or tampons in the middle of the night
  • Menstrual flow or bleeding lasting more than 1 week
  • Passage of blood clots which are the size of a quarter or larger
  • Inability to perform regular daily activities because of the bleeding
  • Signs and symptoms of anemia which include tiredness, fatigue and shortness of breath
  • Constant lower abdominal and pelvic pain.

Tests and diagnosis of menorrhagia

Your health care provider may use several methods to evaluate for menorrhagia and include:1,2

  • Physical exam
  • Bleeding diary
  • Blood tests to evaluate for disorders such as anemia, thyroid disease and clotting disorders
  • Pap Smear to evaluate for cervical infection,inflammation, dysplasia and cancer
  • Endometrial biopsy to test the lining of the uterus for cellular abnormalities and cancer
  • Ultrasoundto evaluate the pelvic organs including the uterus, ovaries and pelvis
  • Sonohysterogram, a procedure in which fluid is instilled into the uterus and an ultrasound evaluates the uterus for abnormalities
  • Hysteroscopy, a procedure in which a camera is inserted into the uterus for evaluation of the lining
  • Dilation and curettage (D&C) is a procedure generally completed in the operating room in which the lining of the uterus is scraped and evaluated for abnormalities.

Treatment and prevention of menorrhagia

Treatment of menorrhagia is dependent on each woman’s personal situation and may include interventions such as:1,2

Drug therapy:

  • Iron supplementation to treat anemia
  • Non-steroidal anti-inflammatories (NSAIDs) to treat dysmenorrhea (painful menstrual cramps) and aid in blood loss reduction. NSAIDs include ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve). At times, bleeding risk can increase while taking NSAIDs
  • Tranexamic acid (Lysteda), when taken at the time of bleeding, is a medication which aids in the reduction of blood loss
  • Oral contraceptives aid in menstrual cycle regulation and decrease bleeding duration and quantity
  • Oralprogesterone is used to treat hormonal imbalance and decrease bleeding
  • Hormonal IUD thins the lining of the uterus and decreases bleeding amount; it is also beneficial in decreasing uterine cramping
  • Desmopressin nasal spray (Stimate) is used in certain situations when bleeding disorders such as von Willebrand’s disease or mildhemophilia are present to increase blood-clotting proteins.

Surgical interventions:

  • Dilation and curettage (D&C) is a procedure generally completed in the operating room in which the lining of the uterus is scraped and evaluated for abnormalities
  • Uterine artery embolization is a procedure used to treat menorrhagia in women with fibroids; this procedure involves passing a catheter through the femoral artery to the uterine arteries, at which time the blood vessel is injected with plastic microspheres
  • Hysteroscopy, a procedure in which a camera is inserted into the uterus for evaluation of the lining; this method can aid in the removal of fibroids, polyps and the uterine lining
  • Focused ultrasound ablation is a procedure in which ultrasonic waves are used to kill fibroid tissue
  • Myomectomy is a procedure in which uterine fibroids are surgically removed either through several small abdominal incisions, an open abdominal incision or through the vagina
  • Endometrial ablation is a procedure in which the lining of the uterus is permanently destroyed
  • Endometrial resection is a procedure in which an electrosurgical wire loop is used to remove the uterine lining
  • Hysterectomy, which removes the uterus and cervix and at times the ovaries.

If you have a concern that you may be suffering from menorrhagia, it is important to speak with your health care provider for evaluation.

Written by Lori Smith, NP, nurse practitioner



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