Menorrhagia (Heavy Menstrual Bleeding): Causes, Symptoms, Treatment

Menorrhagia is a common condition in women. The disorder can result in abnormal menstrual bleeding lasting for more than a week. The condition affects one in every twenty women. The condition can cause prolonged or abnormal bleeding. Heavy menstrual bleeding is a common concern among women. But, when you experience severe bleeding it can result in the medical condition. The main concern of the problem is your inability to maintain usual activities. Heavy periods can also cause cramping and discomfort. You start to dread your monthly periods. So, you need to talk to your doctor about the condition. With effective treatment methods, you can manage the condition.

Symptoms Of Menorrhagia

Menorrhagia How can you detect heavy menstrual bleeding? When you experience one or more of the symptoms suggested below, it indicates you have menorrhagia:

  • Menstrual bleeding soaks through one or more sanitary pads/tampons for every hour for several successive hours
  • You need to use double sanitary protection to control your menstrual bleeding
  • Need to wake up at night to change your sanitary protection
  • Bleeding for more than one week
  • Passing blood clots (that have larger than a quarter’s size)
  • The menstrual flow restricts your daily activity
  • You experience symptoms of anemia (shortness of breath, fatigue or tiredness)

You need to seek immediate medical assistance when you soak your sanitary pad or tampon an hour more than a few hours. It is also important to see a doctor when you experience vaginal bleeding after menopause or suffer from bleeding between the periods. Irregular periods indicate something is wrong in your body. So, it is always advised to get a medical opinion.

Causes Of Menorrhagia

Heavy menstrual bleeding can result from some unknown reasons. But, some medical condition can result in menorrhagia. The common causes triggering the uncomfortable problem are:

Hormonal Imbalance

In a normal menstrual cycle, your body has a balance between estrogen and progesterone hormones. It helps regulate the buildup of a women’s uterus lining also known as the endometrium. The uterus lining sheds during the menstruation. When you experience hormonal imbalance, the uterus lining develops in excess. It sheds during the menstruation leading to heavy bleeding. Several underlying conditions can result in hormonal imbalances like:

Ovaries Dysfunction

The dysfunction of your ovaries can result in the condition. When your ovaries fail to release an egg (ovulation) during the menstrual cycle, it fails to produce progesterone hormone. The anovulatory cycle can result in hormonal imbalance. So, you can experience heavy menstrual bleeding.

Uterine Fibroids

Uterine Fibroids

When you develop benign (noncancerous) tumors in the uterus, known as fibroids, it can result in abnormal menstrual bleeding. Women in their childbearing years can develop fibroids. In such cases, you can experience prolonged or heavier than normal menstrual bleeding.



Small, benign growths on the lining of the uterus (uterine polyps) may cause heavy or prolonged menstrual bleeding.



This condition occurs when glands from the endometrium become embedded in the uterine muscle, often causing heavy bleeding and painful periods.

Intrauterine Device (IUD)

Intrauterine Device (IUD)

People using the non-hormonal intrauterine device for birth control can result in menorrhagia. So, you need to talk to your doctor about the other alternative options for effective birth control without the side effects like heavy menstrual bleeding.

Pregnancy Complications

Some women who are of childbearing age can experience a miscarriage. The heavy, late period that occurs just a single time can suggest miscarriage. Women may not know about the pregnancy resulting in thinking it as abnormal menstrual bleeding.


In some cases, cancer of the uterus or cervix can result in heavy menstrual bleeding. So, women who suffer from the cervix or uterine cancer. It affects women who have prior abnormal Pap test or postmenopausal.

Inherited Bleeding Disorders

You can inherit some bleeding disorders leading to the heavy menstrual bleeding. When you suffer from the condition, the blood-clotting factor becomes impaired or deficient. Conditions like von Willebrand’s disease can cause abnormal periods,


Some medications can cause heavy menstrual bleeding. So, if you take the following medications, then you can experience heavier bleeding during your periods:

  • Anticoagulants (for example, warfarin)
  • Anti-inflammatory medications
  • Enoxaparin
  • Hormonal medications (for example, progestins and estrogen)

You can experience prolonged or heavy bleeding during your menstrual cycle.

Other Conditions

You can suffer from a serious condition that can contribute to heavy menstrual bleeding. So, if you suffer from kidney disease or liver problem, then you can suffer from the issue.

If you suffer from the above-mentioned condition, then consult your doctor. You need to get the problem under control to avoid it from affecting your normal life.

Risk Factors Leading To Menorrhagia

Not every woman suffers from heavy menstrual bleeding. The possibility of the condition varies with age and the presence of a medical condition that can result in heavy bleeding during your menstrual cycle. In a normal women’s cycle, the ovaries release the egg. It triggers the production of progesterone, it is the female hormone that keeps your periods regular. But, without the release of an egg, your body cannot produce enough progesterone. So, it results in heavy menstrual bleeding. So, the risk factors associated with the condition are:

Menorrhagia In Adolescent Girls

Anovulatory is a common problem in adolescent girls. So, they can experience heavy menstrual bleeding. It usually occurs during the first year after they get their first menstrual period. It is also known as menarche.

Menorrhagia In Older Women

In older women, heavy bleeding occurs due to uterine pathology in older women of reproductive age. The different causes leading to the condition are:

  • Adenomyosis
  • Polyps
  • Fibroids

But, the doctor needs to perform an extensive diagnosis to rule out other serious condition that causes similar signs. The problems your doctor needs to rule out are:

So, it is essential to diagnose the exact cause of the problem to develop a proper treatment plan.

Complications Due To Menorrhagia

Heavy menstrual bleeding needs management. Else, you can experience several problems. Excessive and prolonged bleeding can trigger other medical condition. So, without proper management, the condition can lead to the following:



Women who suffer from heavy bleeding during their period can experience anemia. The loss of blood can result in reducing the circulating red blood cell numbers. Normally, the number of red blood cells circulating in your body is measured by hemoglobin. Hemoglobin refers to the protein that enables the red blood cells in the body to carry oxygen to the tissues. When you lose too much blood, your body attempts to compensate for it by using the iron stores used to make more hemoglobin. So, the heavy bleeding can reduce iron levels leading to anemia. Due to the condition, you can experience the following signs:

  • Fatigue
  • Pale skin
  • Weakness

Your diet plays an important role in iron deficiency anemia. But, heavy menstrual periods can complicate the condition.

Severe Pain

Usually, heavy bleeding accompanies with pain. You can experience painful cramps known medically as dysmenorrhea. It can affect your normal life. You feel unable to perform the various tasks due to the severe pain. In some cases, the cramps become severe. So, you require a medical evaluation to manage the pain.

Diagnosis Of Menorrhagia

When heavy menstrual bleeding starts affecting your daily life, you need to see a doctor. It is also important to see a doctor if you experience severe fatigue and weakness. It is an indication of low levels of iron in your body. So, you need to make an appointment with your doctor. The doctor can perform the following diagnostic tests to detect the cause of heavy bleeding.

Note Menstrual Cycle

Your doctor can ask about your medical history and details about your menstrual cycle. You need to note important information about the bleeding and nonbleeding days in your diary. You must also note about the heaviness of the menstrual flow. Make note of the number of pads/tampons you need to control it.

Physical Assessment

After getting information about your menstrual cycle, your doctor performs a physical assessment. Other tests are suggested to determine the underlying problem leading to the condition. Based on the assessment, your doctor can suggest other tests.

Blood Tests

You need to provide a sample of blood. It is sent to the lab for testing various conditions. The blood tests can detect the following:

Pap Test.

It is the test that checks for infection, inflammation or the presence of cancerous cells in your cervix. A sample of the cells from the cervix is collected by the doctor. It is analyzed in the lab to detect the changes that can lead to severe issues.

Endometrial Biopsy

It is the test during which your doctor takes the sample of tissue present inside the uterus. It is examined by a pathologist to detect problems.


The test uses sound waves to produce images of the uterus. It also provides a detailed image of the pelvic region and ovaries. Your doctor assesses the images to check for abnormalities that cause menorrhagia.

Other Tests

Based on the results of the tests suggested above, your doctor can suggest other tests for detailed evaluation. The tests are:


During the test, a fluid is injected into the uterus through a tube. The fluid travels through the vagina and cervix to reach the uterus. Then, the doctor uses an ultrasound scan to look for problems in the uterus lining.


This exam involves inserting a thin, lighted instrument through your vagina and cervix into your uterus, which allows your doctor to see the inside of your uterus.

The proper diagnosis of heavy menstrual bleeding is possible only after ruling out underlying medical conditions, menstrual disorders or effect of medications that leads to the condition or worsens it.

Treatment For Menorrhagia

Heavy menstrual bleeding can affect your everyday routine. You have to change pads several times a day. It can cause inconvenience to you. Apart from that, excess bleeding can make you anemic. Therefore, your doctor suggests treatments to manage the condition. The specific treatment for menorrhagia depends on several factors like:

  • The cause of the condition
  • Your overall health
  • The severity of the condition
  • Your medical history
  • The chances of your heavy periods becoming less heavy
  • Your tolerance to specific medications, therapies or procedures
  • The plans to have a child in the future
  • The adverse effects of the condition on your lifestyle
  • Your preference for the specific type of treatment

Based on the data collected, your doctor can suggest one the best treatment options to manage the condition. It will help reduce bleeding and live a normal life.

Medications To Control Menorrhagia

You can suffer pain and severe discomfort due to the heavy menstrual bleeding. So, your doctor can suggest medications to relieve the symptoms associated with the condition. The medications prescribed include:


Nonsteroidal anti-inflammatory medication can offer relief from severe menstrual blood loss. It can also offer comfort by easing the menstrual cramps. The menstrual cramps known as dysmenorrhea can make it impossible for you to perform your daily functions. So, you can take ibuprofen or naproxen sodium to manage the condition.

Tranexamic acid

The medications containing tranexamic acid can reduce menstrual blood loss. You need to take the medication only at the time of your periods.

Oral Contraceptives

Oral contraceptives are effective in controlling excessive bleeding. Apart from providing birth control, it can regulate your menstrual cycle. It also reduces episodes of prolonged or excessive bleeding.

Oral Progesterone

At time hormonal imbalance can result in excess bleeding. So, your doctor prescribes oral progesterone to correct the hormone imbalance. It is also effective in reducing menorrhagia.

Hormonal IUD

Your doctor suggests inserting a device. The intrauterine device can release a certain type of progestin into the uterus. The progestin known as levonorgestrel can thin the uterine lining. So, it can offer relief from heavy menstrual bleeding and cramping.

Changing Medication

Taking certain hormone medication can lead to heavy menstrual bleeding. So, your doctor treats the condition by changing the dose of the medication or stopping it altogether.

Treating anemia

Heavy menstrual bleeding can result in anemia. So, you need to take iron supplements regularly. The doctor checks your iron levels. If they are low, then you need to start taking iron supplements. So, your doctor does not wait until you become anemic. Iron supplements can help combat blood loss.

Invasive Procedures To Treat Menorrhagia

In some cases, medicines cannot offer you relief. In such cases, your doctor can suggest surgical treatment to manage heavy menstrual bleeding. It is suggested when medical therapy becomes unsuccessful. So, the invasive procedure to manage the condition includes:

Dilation And Curettage (D&C)

It is the procedure during which the doctor opens the cervix. It is known as dilation. Then, the doctor suctions or scrapes the tissue from the uterus lining. It can reduce heavy bleeding. It is an effective method to treat active or acute bleeding. But, you need additional dilation and curettage procedure if the heavy bleeding recurs.

Uterine Artery Embolization

At time fibroids developing in the uterus can result in menorrhagia. Uterine artery embolization can shrink the fibroids in the uterus. The fibroids can cut the blood supply of the uterine arteries by blocking it. During the surgery, the surgeon passes a catheter through your femoral artery (the large artery present in your thigh). The catheter is guided to the uterine arteries. Your surgeon injects the blood vessels with materials to reduce the blood flow to the fibroid. It results in the shrinking of the fibroids and manages heavy menstrual bleeding.

Focused Ultrasound Surgery

It is also a method to treat heavy menstrual bleeding due to the presence of fibroids. Focused ultrasound surgery treats the bleeding by shrinking the fibroids in the uterus. It uses ultrasound waves to destroy fibroid growth. You need no incisions to treat the condition.


It is the procedure involving surgical removal of the fibroids from the uterus. The type of myomectomy is decided based on the size of the fibroids, its number, and the location in the uterus. Your doctor can opt from either open abdominal surgery or laparoscopic surgery. Open abdominal surgery takes more time to heal while laparoscopic surgery uses small incisions, which heals quickly. Another method is removing it through your vagina and cervix (hysteroscopic removal)

Endometrial Ablation

Endometrial Ablation

It is the procedure that ablates the endometrium. So, the procedure can destroy the uterus lining using radiofrequency, laser or heat. It is applied on endometrium to destroy the tissue, causing heavy bleeding. Most women who undergo the procedure have lighter periods. But, getting pregnant after the procedure involves complication. Therefore, if you choose the procedure, try to use a permanent or reliable contraception method. It is required until you experience menopause.

Endometrial Resection

It is the surgical procedure, which uses the electrosurgical wire loop to remove the uterus lining. It is suggested for women who experience menorrhagia. But, women who undergo the procedure must refrain from getting pregnant.


In severe cases, the doctor suggests hysterectomy. It is the surgery to remove the cervix and uterus permanently. The surgery is only suggested for women who are past their child-bearing age. It is because the procedure can result in sterility. So, you will not get menstrual periods after the procedure. The procedure performed under anesthesia. Therefore, you need to get admitted to the hospital. In some cases, women suffering from the condition need bilateral oophorectomy (removal of ovaries). The procedure can result in premature menopause.


Most of the invasive procedures suggested above are mostly done on an outpatient basis. It requires a general anesthetic. So, you can go home after the procedure on the same day. But, some procedures like hysterectomy or myomectomy needs hospitalization. In some cases, heavy menstrual bleeding signifies another condition. Underlying diseases like thyroid disease can result in menorrhagia. Once you get treatment for the thyroid problem, you can see lighter periods.

Preventing Menorrhagia

You cannot prevent heavy menstrual bleeding. Talking to your doctor and proper diagnosis of the issue is the only possible method to manage the condition. With a proper treatment plan, you can prevent other health complications in the future.


Experiencing menorrhagia is common. You never to worry about it. With different techniques, you can manage the condition. You need to see your doctor diagnose the issue properly. Based on the diagnosis, your doctor can suggest the best technique to deal with the symptoms. Understanding the underlying problem is essential to get the ideal treatment. It will help reduce the intensity and duration of the menstrual bleeding. You need to work with your doctor to determine the best approach, including medication or surgery to deal with the problem. It will help you continue your normal life without the heavy bleeding affecting it. So, you can curb the fear of monthly menstrual bleeding with the best solutions that suit your condition.

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