Learn about the causes and treatment of heavy menstrual periods.
Menorrhagia is the medical term for menstrual periods with abnormally heavy or prolonged bleeding. Although heavy menstrual bleeding is a common concern, most women don't experience blood loss severe enough to be defined as menorrhagia.
With menorrhagia, you can't maintain your usual activities when you have your period because you have so much blood loss and cramping. If you dread your period because you have such heavy menstrual bleeding, talk with your doctor. There are many effective treatments for menorrhagia.
Signs and symptoms of menorrhagia may include:
Seek medical help before your next scheduled exam if you experience:
In some cases, the cause of heavy menstrual bleeding is unknown, but a number of conditions may cause menorrhagia. Common causes include:
Hormone 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 hormone imbalance occurs, the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding.
A number of conditions can cause hormone imbalances, including polycystic ovary syndrome (PCOS), obesity, insulin resistance and thyroid problems.
There are three major types of uterine fibroids. Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus. Some submucosal or subserosal fibroids may be pedunculated — hanging from a stalk inside or outside the uterus.
Risk factors vary with age and whether you have other medical conditions that may explain your menorrhagia. In a normal cycle, the release of an egg from the ovaries stimulates the body's production of progesterone, the female hormone most responsible for keeping periods regular. When no egg is released, insufficient progesterone can cause heavy menstrual bleeding.
Menorrhagia in adolescent girls is typically due to anovulation. Adolescent girls are especially prone to anovulatory cycles in the first year after their first menstrual period (menarche).
Menorrhagia in older reproductive-age women is typically due to uterine pathology, including fibroids, polyps and adenomyosis. However, other problems, such as uterine cancer, bleeding disorders, medication side effects and liver or kidney disease could be contributing factors.
Excessive or prolonged menstrual bleeding can lead to other medical conditions, including:
Anemia. Menorrhagia can cause blood loss anemia by reducing the number of circulating red blood cells. The number of circulating red blood cells is measured by hemoglobin, a protein that enables red blood cells to carry oxygen to tissues.
Iron deficiency anemia occurs as your body attempts to make up for the lost red blood cells by using your iron stores to make more hemoglobin, which can then carry oxygen on red blood cells. Menorrhagia may decrease iron levels enough to increase the risk of iron deficiency anemia.
Signs and symptoms include pale skin, weakness and fatigue. Although diet plays a role in iron deficiency anemia, the problem is complicated by heavy menstrual periods.
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:
Based on the results of your initial tests, your doctor may recommend further testing, including:
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.
During hysterosonography (his-tur-o-suh-NOG-ruh-fee), a care provider uses a thin, flexible tube (catheter) to inject salt water (saline) into the hollow part of the uterus. An ultrasound probe gets images of the inside of the uterus to check for anything unusual.
Specific treatment for menorrhagia is based on a number of factors, including:
Medical therapy for menorrhagia may include:
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.
If you also have anemia due to your menorrhagia, 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.
You may need surgical treatment for menorrhagia if medical therapy is unsuccessful. Treatment options include:
Endometrial ablation. This procedure involves destroying (ablating) the lining of your uterus (endometrium). The procedure uses a laser, radiofrequency or heat applied to the endometrium to destroy the tissue.
After endometrial ablation, most women have much lighter periods. Pregnancy after endometrial ablation has many associated complications. If you have endometrial ablation, the use of reliable or permanent contraception until menopause is recommended.
Many of these surgical procedures are 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. An abdominal myomectomy or a hysterectomy usually requires a hospital stay.
When menorrhagia is a sign of another condition, such as thyroid disease, treating that condition usually results in lighter periods.
Small particles (embolic agents) are injected into the uterine artery through a small catheter. The embolic agents then flow to the fibroids and lodge in the arteries that feed them. This cuts off blood flow to starve the tumors.
If your periods are so heavy that they limit your lifestyle, make an appointment with your doctor or other health care provider.
Here's some information to help you prepare for your appointment and what to expect from your provider.
To prepare for your appointment:
For menorrhagia, some basic questions to ask your doctor include:
Don't hesitate to ask any other questions that occur to you during your appointment.
Your doctor is likely to ask you a number of questions, such as:
While you wait for your appointment, check with your family members to find out if any relatives have been diagnosed with bleeding disorders. In addition, start jotting down notes about how often and how much you bleed over the course of each month. To track the volume of bleeding, count how many tampons or pads you saturate during an average menstrual period.