is the medical term for excessive bleeding at the
time of the menstrual period, either in number of
days or amount of blood or both.
Almost every woman at some time in her
reproductive life experiences heavy bleeding during
her menstrual period. Some women have heavy periods
almost every cycle. Menorrhagia - the Greek
roots men meaning "month" and rhegnynai
meaning "to burst forth" - is the medical term for
excessive or prolonged menstrual bleeding or both.
The condition is also known as hypermenorrhea.
The menstrual cycle isn't the same for every
woman. Normal menstrual flow occurs about every 28
days, lasts four to five days and produces a total
blood loss of 60 to 250 milliliters (4 tablespoons
to about 1 cup). Your period may be regular or
irregular, light or heavy, painful or pain-free,
long or short and still be considered normal.
Although about one-third of premenopausal women
complain of heavy menstrual bleeding, only one in 10
women experience blood loss severe enough to be
defined as Menorrhagia. Some women with Menorrhagia
often find it necessary to miss time at work, school
or social activities, due to the severity of their
Signs and symptoms
The signs and symptoms of menorrhagia include:
that soaks through one or more sanitary pads or tampons every hour
for several consecutive hours
The need to use
double sanitary protection to control your menstrual flow
The need to change
sanitary protection during the night
that lasts longer than seven days
that includes large blood clots
flow that interferes with your regular lifestyle
Constant pain in
the lower abdomen during menstrual period
or shortness of breath (symptoms of anemia)
In some cases the cause of heavy menstrual bleeding is unknown, but a
number of conditions may cause menorrhagia. Common causes include:
In a normal menstrual cycle, a balance between the hormones estrogen
and progesterone regulates the buildup of the lining of the uterus
(endometrium), which you shed during menstruation. If a hormonal
imbalance occurs, the endometrium develops in excess and eventually
sheds by way of heavy menstrual bleeding. Hormonal imbalance occurs
most often in adolescent girls experiencing their menstrual periods
for the first time or in women approaching menopause. Menorrhagia
caused by certain conditions involving hormonal imbalance, such as
thyroid disease, often can be controlled with hormone medications.
However, improper use of hormone medications can be a direct cause
These noncancerous (benign) tumors of the uterus appear during your
child-bearing years. Uterine fibroids may cause heavier-than-normal
or prolonged menstrual bleeding.
Together, hormonal imbalance and uterine fibroids account for about 80
percent of all cases of menorrhagia. Other causes may include:
The development of small benign growths on the uterine wall (uterine
polyps) may cause heavy or prolonged menstrual bleeding. Polyps of
the uterus most commonly occur in women of reproductive age as the
result of excessive hormone production or consumption and can lead
to bleeding not associated with menstruation (spotting).
These fluid-filled sacs or pockets occur within or on the ovary.
Ovarian cysts are often benign and rarely cause menstrual
irregularities, including menorrhagia.
Failure of the
ovaries to produce, mature or release eggs (anovulation) may cause
hormonal imbalance and result in menorrhagia.
This condition occurs when glands from the
endometrium become embedded in the uterine muscle, often causing
heavy bleeding and pain. Adenomyosis is most likely to develop if
you're a middle-age woman who has had many children.
Menorrhagia is a
well-known side effect of using an intrauterine device for birth
control. When an IUD is the cause of excessive menstrual bleeding,
you'll often need to remove it. Light spotting is normal with the
use of an IUD and, with no other symptoms present, is most likely
A single heavy
period that's late may be due to a miscarriage. If bleeding occurs
at the usual time of menstruation, however, miscarriage is less
likely to be the cause. An ectopic pregnancy, implantation of a
fertilized egg within the fallopian tube instead of the uterus, also
may cause menorrhagia.
Rarely, certain female reproductive cancers may cause menorrhagia.
Uterine cancer, ovarian cancer and cervical cancer can cause
excessive vaginal bleeding.
Certain drugs, including those that prevent the clotting of blood
(anticoagulants) and anti-inflammatory medications, can contribute
to heavy or prolonged menstrual bleeding.
A number of other
medical conditions may cause or increase your risk of menorrhagia.
Pelvic inflammatory disease (PID), thyroid problems, endometriosis,
lupus, liver or kidney disease, some uncommon blood disorders,
certain cancers and chemotherapy may cause menorrhagia.
Any woman at any time in her reproductive life may experience heavy
menstrual bleeding. Young women who aren't yet ovulating regularly may
be especially prone to menorrhagia in the first 12 to 18 months after
their first menstrual period (menarche). Older women approaching
menopause often experience hormonal imbalance that can cause
menorrhagia. Women at higher risk also include those with hereditary
When to seek medical advice
Doctors generally recommended that all sexually active women and women
over the age of 18 have yearly pelvic exams and regular Pap tests.
However, if you experience irregular vaginal bleeding, schedule an
appointment with your doctor and be certain to record when the bleeding
occurs during the month. If you're having heavy vaginal bleeding —
soaking at least one pad or tampon an hour for more than a few hours —
seek medical help. Call your doctor if you have severe menstrual pain
that doesn't respond to at-home treatment or if you have vaginal
bleeding after menopause.
Screening and diagnosis
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:
A sample of your blood is evaluated for any abnormalities due to
excessive blood loss during menstruation.
Your doctor collects cells from your cervix for microscopic
examination to detect infection, inflammation, or changes that may
be cancerous or may lead to cancer.
Your doctor takes a sample of tissue from the inside of your uterus
to be examined under a microscope.
This method scan uses sound waves to produce pictures of your
uterus, ovaries and pelvis.
This ultrasound scan is done after fluid is injected through a tube
into the uterus by way of your vagina and cervix. This allows your
doctor to look for problems in the lining of your uterus.
A tiny tube with a light inserted through your vagina and cervix
into the uterus allows your doctor to see the inside of your uterus.
curettage (D and C).
In this procedure, your doctor opens (dilates) your cervix and then
inserts a spoon-shaped instrument (curette) into your uterus to
collect tissue from the lining of your uterus to be examined in the
A dye is injected into your uterus and fallopian tubes through the
cervix, and X-rays are taken to determine the shape and size of your
uterus and fallopian tubes.
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 the condition.
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