Heavy Menstrual Periods

Heavy Menstrual Periods

General Infomation

At some time in your reproductive life, you've probably experienced heavy bleeding during your menstrual period. If you're like some women, every period you have causes enough blood loss and cramping that you can't maintain your usual daily activities. The medical term for periods like these — excessive or prolonged or both — is menorrhagia.
Although heavy menstrual bleeding is a common concern among premenopausal women, few women experience blood loss severe enough to be defined as menorrhagia. If you have menstrual bleeding so heavy that you dread your period, talk with your doctor. There are many effective treatments for menorrhagia.


Normal menstrual flow:
• Occurs every 21 to 35 days
• Lasts four to five days
• Produces a total blood loss of about 2 to 3 tablespoons (30 to 44 milliliters)
The menstrual cycle isn't the same for every woman. Your period may be regular or irregular, light or heavy, painful or pain-free, long or short and still be considered normal. Menorrhagia refers to losing about 5 1/2 tablespoons (81 milliliters) or more of blood during your menstrual cycle.
The signs and symptoms of menorrhagia may include:
• Menstrual flow that soaks through one or more sanitary pads or tampons every hour for several consecutive hours
• The need to use double sanitary protection to control your menstrual flow
• The need to change sanitary protection during the night
• Menstrual periods lasting longer than seven days
• Menstrual flow that includes large blood clots
• Heavy menstrual flow that interferes with your regular lifestyle
• Tiredness, fatigue or shortness of breath (symptoms of anemia)
When to see a doctor
Doctors generally recommend that all sexually active women and women over the age of 21 have yearly pelvic exams and regular Pap tests. However, if you experience heavy or irregular vaginal bleeding, schedule an appointment with your doctor and be certain to record when the bleeding occurs during the month. If you're having heavy vaginal bleeding — soaking at least one pad or tampon an hour for more than a few hours — seek medical help. Call your doctor if you have any vaginal bleeding after menopause.

Causes & Complication

In some cases, the cause of heavy menstrual bleeding is unknown, but a number of conditions may cause menorrhagia. Common causes include:
• Hormonal imbalance. In a normal menstrual cycle, a balance between the hormones estrogen and progesterone regulates the buildup of the lining of the uterus (endometrium), which is shed during menstruation. If a hormonal imbalance occurs, the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding.
• Dysfunction of the ovaries. Lack of ovulation (anovulation) may cause hormonal imbalance and result in menorrhagia.
• Uterine fibroids. These noncancerous (benign) tumors of the uterus appear during your childbearing years. Uterine fibroids may cause heavier than normal or prolonged menstrual bleeding.
• Polyps. Small, benign growths on the lining of the uterine wall (uterine polyps) may cause heavy or prolonged menstrual bleeding. Polyps of the uterus most commonly occur in women of reproductive age as the result of high hormone levels.
• Adenomyosis. This condition occurs when glands from the endometrium become embedded in the uterine muscle, often causing heavy bleeding and pain. Adenomyosis is most likely to develop if you're a middle-aged woman who has had many children.
• Intrauterine device (IUD). Menorrhagia is a well-known side effect of using a nonhormonal intrauterine device for birth control. When an IUD is the cause of excessive menstrual bleeding, you may need to remove it.
• Pregnancy complications. A single, heavy, late period may be due to a miscarriage. If bleeding occurs at the usual time of menstruation, however, miscarriage is unlikely to be the cause. An ectopic pregnancy — implantation of a fertilized egg within the fallopian tube instead of the uterus — also may cause menorrhagia.
• Cancer. Rarely, uterine cancer, ovarian cancer and cervical cancer can cause excessive menstrual bleeding.
• Inherited bleeding disorders. Some blood coagulation disorders — such as von Willebrand's disease, a condition in which an important blood-clotting factor is deficient or impaired — can cause abnormal menstrual bleeding.
• Medications. Certain drugs, including anti-inflammatory medications and anticoagulants (to prevent blood clots), can contribute to heavy or prolonged menstrual bleeding. Improper use of hormone medications also can cause menorrhagia.
• Other medical conditions. A number of other medical conditions, including pelvic inflammatory disease (PID), thyroid problems, endometriosis, and liver or kidney disease, may cause menorrhagia.


Excessive or prolonged menstrual bleeding can lead to other medical conditions, including:
• Iron deficiency anemia. In this common type of anemia, your blood is low on hemoglobin, a substance that enables red blood cells to carry oxygen to tissues. Low hemoglobin may be the result of insufficient iron. Menorrhagia may deplete iron levels enough to increase the risk of iron deficiency anemia. Signs and symptoms include pallor, weakness and fatigue.
Although diet plays a role in iron deficiency anemia, the problem is complicated by heavy menstrual periods. Most cases of anemia are mild, but even mild anemia can cause weakness and fatigue. Moderate to severe anemia can also cause shortness of breath, rapid heart rate, lightheadedness and headaches.
• Severe pain. Heavy menstrual bleeding often is accompanied by menstrual cramps (dysmenorrhea). Sometimes the cramps associated with menorrhagia are severe enough to require prescription medication or a surgical procedure.

Tests and Diagnosis: 

Your doctor will most likely ask about your medical history and menstrual cycles. You may be asked to keep a diary of bleeding and nonbleeding days, including notes on how heavy your flow was and how much sanitary protection you needed to control it. Your doctor will do a physical exam and may recommend one or more tests or procedures such as:
• Blood tests. A sample of your blood is evaluated in case excessive blood loss during menstruation has made you anemic. Tests may also be done to check for thyroid disorders or blood-clotting abnormalities.
• Pap test. Your doctor collects cells from your cervix for microscopic examination to detect infection, inflammation or changes that may be cancerous or may lead to cancer.
• Endometrial biopsy. Your doctor takes a sample of tissue from the inside of your uterus to be examined under a microscope.
• Ultrasound scan. This imaging method uses sound waves to produce images of your uterus, ovaries and pelvis.
Based on the results of your initial tests, your doctor may recommend further testing, including:
• Sonohysterogram. This ultrasound scan is done after fluid is injected through a tube into the uterus by way of your vagina and cervix. This allows your doctor to look for problems in the lining of your uterus.
• Hysteroscopy. A tiny tube with a light is inserted through your vagina and cervix into the uterus, which allows your doctor to see the inside of your uterus.
• Dilation and curettage (D and C). In this procedure, your doctor opens (dilates) your cervix and then inserts a spoon-shaped instrument (curet) into your uterus to collect tissue from the uterine lining. This tissue is examined in the laboratory.
Doctors can be certain of a diagnosis of menorrhagia only after ruling out other menstrual disorders, medical conditions or medications as possible causes or aggravations of this condition.

Medication & Prevention
Treatments and Drugs: 

Specific treatment for menorrhagia is based on a number of factors, including:
• Your overall health and medical history
• The cause and severity of the condition
• Your tolerance for specific medications, procedures or therapies
• The likelihood that your periods will become less heavy before long
• Your future childbearing plans
• Effects of the condition on your lifestyle
• Your opinion or personal preference
Drug therapy for menorrhagia may include:
• Iron supplements. If the condition is accompanied by anemia, your doctor may recommend that you take iron supplements regularly. If your iron levels are low but you're not yet anemic, you may be started on iron supplements rather than waiting until you become anemic.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen (Advil, Motrin, others), help reduce menstrual blood loss. NSAIDs have the added benefit of relieving painful menstrual cramps (dysmenorrhea).
• Oral contraceptives. Aside from providing effective birth control, oral contraceptives can help regulate menstrual cycles and reduce episodes of excessive or prolonged menstrual bleeding.
• Oral progesterone. When taken for 10 or more days of each menstrual cycle, the hormone progesterone can help correct hormonal imbalance and reduce menorrhagia.
• The hormonal IUD (Mirena). This type of intrauterine device releases a type of progestin called levonorgestrel, which makes the uterine lining thin and decreases menstrual blood flow and cramping.
If you have menorrhagia from taking hormone medication, you and your doctor may be able to treat the condition by changing or stopping your medication.
You may need surgical treatment for menorrhagia if drug therapy is unsuccessful. Treatment options include:
• Dilation and curettage (D and C). In this procedure, your doctor opens (dilates) your cervix and then scrapes or suctions tissue from the lining of your uterus to reduce menstrual bleeding. Although this procedure is common and often treats menorrhagia successfully, you may need additional D and C procedures if menorrhagia recurs.
• Operative hysteroscopy. This procedure uses a tiny tube with a light (hysteroscope) to view your uterine cavity and can aid in the surgical removal of a polyp that may be causing excessive menstrual bleeding.
• Endometrial ablation. Using a variety of techniques, your doctor permanently destroys the entire lining of your uterus (endometrium). After endometrial ablation, most women have little or no menstrual flow. Endometrial ablation reduces your ability to become pregnant.
• Endometrial resection. This surgical procedure uses an electrosurgical wire loop to remove the lining of the uterus. Both endometrial ablation and endometrial resection benefit women who have very heavy menstrual bleeding. Like endometrial ablation, this procedure reduces your ability to become pregnant.
• Hysterectomy. Surgical removal of the uterus and cervix is a permanent procedure that causes sterility and cessation of menstrual periods. Hysterectomy is performed under anesthesia and requires hospitalization. Additional removal of the ovaries (bilateral oophorectomy) may cause premature menopause in younger women.
Except for hysterectomy, these surgical procedures are usually done on an outpatient basis. Although you may need a general anesthetic, it's likely that you can go home later on the same day.
When menorrhagia is a sign of another condition, such as thyroid disease, treating that condition usually results in lighter periods.

Lifestyle and Home Remedies: 

Consider these tips for successful self-care of menorrhagia:
• Get your rest. Your doctor may recommend rest if bleeding is excessive and disruptive to your normal schedule or lifestyle.
• Keep a record. Record the number of pads and tampons you use so that your doctor can determine the amount of bleeding. Change tampons regularly, at least every four to six hours.
• Avoid aspirin. Because aspirin interferes with blood clotting, avoid it. However, other nonsteroidal anti-inflammatory medications, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve), often are very effective in relieving menstrual discomfort.

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