Heavy Menstrual Bleeding
DefinitionHeavy menstrual bleeding (also called menorrhagia) is excessive menstrual blood loss that interferes with a woman's quality of life.
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CausesIn 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 FactorsFactors that may increase your chances of menorrhagia include:
- Approaching menopause
SymptomsSymptoms 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.
DiagnosisYour 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
TreatmentTreatment depends on the underlying cause of the heavy menstrual bleeding. Your doctor will work with you to create a treatment plan.
MedicationsYour doctor may recommend:
- Hormonal therapy
- An IUD that releases the hormone progesterone
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Iron supplement
Surgical ProceduresIn 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
PreventionThere are no current guidelines to prevent heavy menstrual bleeding.
Office on Women's Health
The American Congress of Obstetricians and Gynecologists
The Canadian Women's Health Network
The Society of Obstetricians and Gynaecologists of Canada
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.
- Reviewer: Andrea Chisholm, MD
- Review Date: 08/2014
- Update Date: 09/30/2013