MENORRHAGIA (Heavy Menstrual Bleeding)


Reference & Photo Credit Mayo Clinics

Menorrhagia is the medical term for menstrual periods with abnormally heavy or prolonged bleeding. Normally heavy and prolonged bleeding are common among premenopausal women, most women don't experience blood loss severe enough to be defined as menorrhagia.

In women with menorrhagia, every period causes enough blood loss and cramping that will affect your activities of daily living. Please, if you have menstrual bleeding so heavy that you dread your period, talk with your doctor, there are many effective treatments for menorrhagia.

?Signs & Symptoms of menorrhagia

These may include:

1. Using one or more sanitary pads or tampons every hour for several consecutive hours in a day

2. Needing to use double sanitary protection to control your menstrual flow

3. Needing to wake up to change sanitary protection during the night

4. Bleeding for longer than a week (normal flow is between 2-7 day)

5. Passing blood clots with menstrual flow for more than one day

6. Restricting daily activities due to heavy menstrual flow

7. Symptoms of anemia, such as tiredness, fatigue or shortness of breath.

?When to see a doctor?

Seek medical help before your next scheduled exam if you experience:
• Vaginal bleeding so heavy it soaks at least one pad or tampon an hour for more than a few hours
• Bleeding between periods or irregular vaginal bleeding
• Any vaginal bleeding after menopause


Most times these can be unknown, however a couple of conditions can cause heavy bleeding.

1. Hormone imbalance

2. Dysfunction of the ovaries.: This will lead to your ovaries not releasing an egg (ovulate) during a menstrual cycle (anovulation), and when this happens, your body doesn't produce the hormone progesterone, as it would during a normal menstrual cycle. This leads to hormone imbalance and may result in menorrhagia.

3. Uterine fibroids: This may cause heavier than normal or prolonged menstrual bleeding.

4. Polyps: These are small, non-cancerous growths on the lining of the womb (uterine polyps) and may cause heavy or prolonged menstrual bleeding. This most commonly occur in women of reproductive age as the result of high hormone levels.

5. Intrauterine device (IUD). Menorrhagia is a well-known side effect of using a non-hormonal intrauterine device for birth control.

6. Pregnancy complications: Normally a single, heavy, late period may be due to a miscarriage, however if bleeding occurs at the usual time of menstruation, however, miscarriage is unlikely to be the cause.

7. An ectopic pregnancy: implantation of a fertilized egg within the fallopian tube instead of the uterus — also may cause menorrhagia.

8. Cancer. Rarely, uterine cancer, ovarian cancer and cervical cancer can cause excessive menstrual bleeding.

9. Inherited bleeding disorders.

10. Medications: Certain drugs, including pain killers like anti-inflammatory medications (ibuprofen) can contribute to heavy or prolonged menstrual bleeding.

11. Other medical conditions. A number of other medical conditions, including pelvic inflammatory disease (PID), thyroid problems, endometriosis, and liver or kidney disease, may be associated with menorrhagia.

?Risk factors

Generally, Menorrhagia is most often due to a hormone imbalance that causes menstrual cycles without ovulation.
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. Menstrual cycles without ovulation (anovulatory cycles) are most common among two separate age groups:
• Adolescent girls who have recently started menstruating.
These girls are especially prone to anovulatory cycles in the first year after their first menstrual period (menarche).
• Older women approaching menopause. Women ages 40 to 50 are at increased risk of hormonal changes that lead to anovulatory cycles.

?Tests and diagnosis

This will involve
• Medical history and menstrual cycles history. 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.
• Physical exam
• Tests or procedures such as:
• Blood tests. A sample of your blood may be evaluated for iron deficiency (anemia) and other conditions, such as thyroid disorders or blood-clotting abnormalities.
• Pap test. In this test, cells from your cervix are collected and tested for infection, inflammation or changes that may be cancerous or may lead to cancer.
• Endometrial biopsy. Your doctor may take a sample of tissue from the inside of your uterus to be examined by a pathologist.
• Ultrasound scan. This imaging method uses sound waves to produce images of your uterus, ovaries and pelvis.

?Treatment & Management of Heavy Flow

Generally specific treatment for menorrhagia is based on a number of factors, including:
1. Your overall health and medical history
2. The cause and severity of the condition
3. Your tolerance for specific medications, procedures or therapies
4. Your future childbearing plans
5. Effects of the condition on your lifestyle
6. Your opinion or personal preference

The treatments may include

• Iron supplements. If you also have anemia, 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.

• Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve), help reduce menstrual blood loss. NSAIDs have the added benefit of relieving painful menstrual cramps (dysmenorrhea).

• Tranexamic acid. Tranexamic acid (Lysteda) helps reduce menstrual blood loss and only needs to be taken at the time of the bleeding.

• Oral contraceptives. Aside from providing birth control, oral contraceptives can help regulate menstrual cycles and reduce episodes of excessive or prolonged menstrual bleeding.
• Oral progesterone. When taken for 10 or more days of each menstrual cycle, the hormone progesterone can help correct hormone imbalance and reduce menorrhagia

• The hormonal IUD (Mirena). This intrauterine device releases a type of progestin called levonorgestrel, which makes the uterine lining thin and decreases menstrual blood flow and cramping.

Please note, 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. When menorrhagia is a sign of another condition, such as thyroid disease, treating that condition usually results in lighter periods.
Note, you may need surgical treatment for menorrhagia if drug therapy is unsuccessful.

?Treatment options include:

1. Dilation and curettage (D&C
2. Uterine artery embolization. For women whose menorrhagia is caused by fibroids, the goal of this procedure is to shrink any fibroids in the uterus by blocking the uterine arteries and cutting off their blood supply.
3. Myomectomy. This procedure involves surgical removal of uterine fibroids.
4. Hysterectomy. Hysterectomy — surgery to remove your uterus and cervix — is a permanent procedure that causes sterility and ends menstrual periods.

Dr. Chudi Ufondu