Menorrhagia is excessive and/or prolonged menstrual bleeding. Although about 30% of women have heavy periods, only 10% of women have menorrhagia. On average, menstrual flow occurs every 28 days and lasts for five days. Four tablespoons to one cup (60-250 milliliters) of blood is lost during this time.

Causes

In some cases the cause of menorrhagia is unknown. However, many conditions have been known to be associated with menorrhagia. These include:

• Menstrual cycle hormone dysfunction (imbalance)

• Cervical or endometrial polyps

• Uterine fibroids

• Infection (pelvic infections)

• Blood-clotting disorders

• Anticoagulant medications (blood thinners)

• Anti-inflammatory medications (large amounts over a long period of time)

• Liver, kidney, or thyroid disease

• Problems with an intrauterine device (IUD)

• Ectopic pregnancy

• Ovarian cysts

• Chronic medical conditions

• Anticoagulant and anti-inflammatory medications

• Cancer of the uterus or cervix (rare)

• Vaginal injury from trauma or sexual abuse

• Complications from pregnancy, such as miscarriage

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. People at greatest risk for menorrhagia include:

• Adolescent girls who have started menstruation within the last 12-18 months

• Women approaching menopause

• Women with hereditary bleeding disorders

• Women who are obese

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)

Diagnosis

Your healthcare provider will ask about your symptoms and medical history. A physical examination including pelvic exam will be done as part of the evaluation. Tests may include:

• Pap Test

• Blood Tests

• Pregnancy Test

• Ultrasound–a test that uses sound waves to examine your reproductive organs (uterus and ovaries)

• Endometrial Biopsy–removal of a sample of endometrial tissue to look for changes in the lining of the uterus

• Dilation and Curettage (D & C)–scraping of the inner lining of the uterus

• Hysteroscopy–examination of the cervix and fallopian tubes using a telescope-like viewing device

Treatment

Treatment of menorrhagia will depend on the underlying cause. Women who experience persistent excessive bleeding should discuss with their healthcare provider whether to take iron supplements to prevent anemia.

If there is no medical disorder causing your menorrhagia, your doctor may prescribe the following:

Prevention

For most women there are no specific steps for prevention. However, if your menorrhagia is caused by a medication, you may prevent the condition by discontinuing use of this medicine.

Menstrual discomfort is better treated with pain relievers such as Motrin and Advil.

RESOURCES:

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

The National Women’s Health Information Center
http://www.4woman.gov

References:

Harvard Guide to Women’s Health. Harvard University Press; 1996.

Mayo Foundation for Medical Education and Research website. Available at: http://www.mayo.edu/. Accessed October 13, 2005.

US National Library of Medicine, National Institutes of Health website. Available at: http://www.nlm.nih.gov/. Accessed October 13, 2005.

University of Utah Health Sciences Center. Available at: http://www.med.utah.edu/healthinfo/adult/women/menor.htm. Accessed October 13, 2005.