Heavy Menstrual Bleeding (Menorrhagia)

Menorrhagia is the medical term that describes heavy menstrual bleeding. It’s common for some people to experience abnormally heavy bleeding during their periods. It can be related to a variety of health conditions and some medications. 

Extremely heavy bleeding can make those days challenging to go through your typical day. Fortunately, there are a few ways you can manage the heavy bleeding. This article will discuss the symptoms, causes, complications, and treatment for menorrhagia.

Symptoms of Menorrhagia

Signs and symptoms of menorrhagia can include:

• Bleeding through a sanitary pad or tampon every one to two hours
• Periods that last longer than a week
• Passing blood clots larger than a quarter during your period
• Needing to restrict usual daily activities due to heavy bleeding
• Anemia symptoms (tiredness, fatigue, shortness of breath)

Causes of Menorrhagia

Sometimes, it’s not clear why some people experience heavier than normal menstrual bleeding. Still, a number of potential causes are known, including:

• Hormonal imbalances
• Ovarian dysfunction: A condition where the ovaries stop functioning normally before the age of 40
• Uterine fibroids: Noncancerous growths in the uterus (womb)
• Uterine polyps: Growths inside the uterus
• Adenomyosis: A condition where uterine tissue grows inside the muscular wall around the uterus
• Pregnancy complications
• Clotting disorders, such as Von Willebrand disease (an inherited disorder)
• Cancer: Such as uterine or cervical cancer

What Medications Can Cause Menorrhagia?

Some medications and medical devices can cause menorrhagia as a side effect. A few examples include:

• Non-hormonal intrauterine device (IUD), such as Paragard
• Hormonal medications, such as estrogen or progesterone
• Anti-inflammatory medications
• Anticoagulants, such as Coumadin (warfarin) and Lovenox (enoxaparin)

Complications Associated With Menorrhagia

The main complication that may develop with menorrhagia is anemia. Anemia is a condition where there aren't enough healthy red blood cells to carry oxygen around your body. The excessive blood loss in menorrhagia can cause anemia. 

Symptoms of anemia include fatigue, lightheadedness, pale skin, dizziness, and shortness of breath.  

How to Treat Menorrhagia

The treatment for menorrhagia depends on the cause and desired outcome. Often, menorrhagia is managed with medications. However, sometimes procedures or surgeries are needed. 

Medication treatments for menorrhagia include:

• Non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen) and Aleve (naproxen), may help reduce pain from cramping and lower inflammation.
• Lysteda (tranexamic acid) helps reduce menstrual blood loss.
• Oral hormonal contraceptives may help correct hormonal imbalances and regulate periods.
• Oral progesterone may help correct a hormonal imbalance and improve heavy bleeding symptoms.
• Hormonal IUDs, such as Mirena or Liletta, help thin the uterine lining and decrease blood flow. 

If the heavy bleeding began after starting a new medication, your healthcare provider might be able to recommend a different type of medication or dose. Changing the medication may stop the menorrhagia completely.

In some cases, medications alone aren’t enough to treat menorrhagia. Your healthcare provider may recommend a procedure, such as:

• Dilation and curettage (D&C): During this procedure, your cervix (the neck of the uterus that connects to the vagina) is dilated. Your healthcare provider then uses tools or suction to remove tissue from the lining of your uterus to stop menstrual bleeding.
• Uterine artery embolization: This procedure cuts off blood supply to fibroids, which usually causes them to shrink.
• Focused ultrasound: This procedure uses high-intensity sound waves to shrink fibroids.
• Myomectomy: This is a surgical procedure done to remove uterine fibroids.
• Endometrial ablation: This surgical procedure removes a thin layer of tissue from the lining of the uterus.
• Endometrial resection: This procedure removes the lining of the uterus with an electrosurgical wire loop.
• Hysterectomy: During this surgical procedure, the uterus is removed.

Are There Tests to Diagnose the Cause of Menorrhagia?

Your healthcare provider will start by asking questions about your medical history and menstrual cycles. They may ask you to keep a journal with notes about bleeding, heaviness of blood flow, number of menstrual products used, and nonbleeding days. 

The symptom menorrhagia can be diagnosed through a review of history and monitoring blood flow. Your healthcare provider will likely do further testing to diagnose the possible causes of heavy bleeding.

Here are some of the tests they may recommend:

• Pap smear: During this test, a sample of cells is collected from your cervix to look for inflammation, infection, and changes in cells that could indicate cancer.
• Blood tests: Your blood may be tested to look for anemia, thyroid problems, or clotting disorders.
• Ultrasound: This imaging test is used to look at the uterus, ovaries (the organs that produce eggs), and pelvis.
• Endometrial biopsy: A sample of tissue is taken from inside your uterus to look for possible diseases.
• Sonohysterography: In this test, fluid is injected into the uterus to help your healthcare provider see if there are any potential problems in the lining of the uterus. 
• Hysteroscopy: During this test, a small instrument with a light is inserted through the vaginal canal to allow your healthcare provider to see the inside of your uterus.

When to See a Healthcare Provider

Make an appointment to see your healthcare provider if you’re experiencing extremely heavy bleeding, such as:

• Bleeding through a tampon or sanitary pad every one to two hours
• Periods that last longer than seven days
• Have blood clots larger than a quarter
• Spotting or bleeding between periods

Summary

Menorrhagia is very heavy menstrual bleeding or prolonged menstrual bleeding. It can be caused by medications or conditions like uterine polyps, fibroids, non-hormonal IUDs, and others.

The excessive bleeding can lead to the development of anemia. Treatment options for heavy bleeding depends on the cause. It may include medications or surgery.

A Word From Verywell

Dealing with heavy periods can be challenging and disrupt your everyday life. If you’re experiencing problems because of heavy bleeding, talk with your healthcare provider. They can help you find the cause and treatment options to manage the heavy bleeding.