Definition

Heavy menstrual bleeding (also called menorrhagia) is excessive menstrual blood loss that interferes with a woman's quality of life.

Menstrual Flow

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Causes

In some cases, the cause is not known. However, many conditions have been associated with menorrhagia, such as:

    
  • Uterine fibroid
  • Bleeding disorders, such as von Willebrand disease
  • Hormonal imbalance
  • Cervical or endometrial polyp
  • Ovarian cyst
  • Certain medications
  • Intrauterine device (IUD)
  • Risk Factors

    Factors that may increase your chances of menorrhagia include:

        
  • Adolescence
  • Approaching menopause
  • Symptoms

    Symptoms of menorrhagia include:

        
  • Menstrual bleeding lasting more than seven days
  • Unusually heavy bleeding (soaking through a sanitary napkin or tampon every hour)
  • Menstrual flow requiring change of sanitary protection during the night
  • Menstrual flow including large clots
  • Menstrual flow interfering with lifestyle
  • Fatigue and/or shortness of breath (symptoms of anemia)
  • When Should I Call My Doctor?

    Call your doctor if you have symptoms of menorrhagia.

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical examination, including a pelvic exam, will be done. Tests 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
  • Examination of the uterus and fallopian tubes—hysteroscopy
  • Treatment

    Treatment depends on the underlying cause of the heavy menstrual bleeding. Your doctor will work with you to create a treatment plan.

    Medications

    Your doctor may recommend:

        
  • Hormonal therapy
  • An IUD that releases the hormone progesterone
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Iron supplement
  • Surgical Procedures

    In some cases, surgery may be needed, such as:

        
  • 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
  • Prevention

    There are no current guidelines to prevent heavy menstrual bleeding.