Heavy Menstrual Bleeding

(Menorrhagia; Hypermenorrhea)

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:

Risk Factors

Factors that may increase your chances of menorrhagia include:

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:

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.

RESOURCES

Office on Women's Health
http://www.womenshealth.gov

The American Congress of Obstetricians and Gynecologists
http://www.acog.org

CANADIAN RESOURCES

The Canadian Women's Health Network
http://www.cwhn.ca

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org

References

Apgar B, Kaufman A, et al. Treatment of menorrhagia. Am Fam Physician. 2007;75(12):1813-1819.

Heavy menstrual bleeding. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 7, 2013. Accessed August 18, 2014.

Menorrhagia (heavy menstrual bleeding). Mayo Clinic website. Available at: http://www.mayoclinic.org/diseases-conditions/menorrhagia/basics/definition/con-20021959. Updated July 2, 2014. Accessed August 18, 2014.

11/20/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: FDA approves Lysteda to treat heavy menstrual bleeding. United States Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm190551.htm. Updated April 16, 2013. Accessed August 18, 2014.

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