Menorrhagia is a condition that affects menstruating women and causes excessively heavy and prolonged bleeding during the menstrual cycle. For most women, a typical menstrual cycle lasts three to five days and 30 to 60mL of blood are lost per cycle. Women who experience menorrhagia usually have periods that last more than seven days and can lose more than 80 mL of blood in a cycle. (Apgar, 2007)
Heavy menstrual bleeding can be common among premenopausal women and is not always a cause for immediate concern; however, menorrhagia can greatly affect a woman’s quality of life. Women with menorrhagia are at risk for iron deficiency anemia, and can also experience pain and cramping so severe that it interferes with normal daily activities. Physician-diagnosed cases of menorrhagia are rare, and women who suspect they may have menorrhagia should consult their doctor to discuss testing and treatment.
What Causes Menorrhagia?
While the exact cause of menorrhagia is unknown, there are a number of factors that contribute to heavy menstrual bleeding. Some factors are easily treated, while others may indicate a more serious condition. They include:
- infections such as pelvic inflammatory disease (PID)
- issues with birth control methods (such as IUDs, or intrauterine devices)
- hormonal imbalance
More serious factors can include:
- liver, kidney, or thyroid disease
- fibroid tumors
- polyps (small, benign growths on the lining of the uterus)
- blood coagulation disorders
What Are the Symptoms of Menorrhagia?
Every woman’s menstrual cycle is different, and heavy periods are not always a sign of a serious medical condition. If you experience heavy or prolonged bleeding each month, however, you may want to talk to your doctor about menorrhagia. The most common symptoms of menorrhagia include:
- needing to change sanitary products every hour
- a period that lasts seven days or longer
- bleeding in between menstrual cycles
- spotting/bleeding when pregnant
- severe anemia
Some symptoms of menorrhagia may resemble other menstrual conditions. It’s important to pay close attention to changes in your cycle and to consult your doctor for diagnosis.
How is Menorrhagia Diagnosed?
Most women are familiar with the details of their cycle, including frequency of sanitary product changes and how many days it lasts. To diagnose potential menorrhagia, your doctor will review your medical history and perform a physical evaluation to rule out other menstrual disorders, medical conditions, or certain medications that may be causing heavy periods.
After the exam, a doctor may order one of the following tests:
- pap smear (an exam to test cells in the cervix for infection or inflammation)
- blood test to check for anemia or identify any blood clotting disorders
- ultrasound of the uterus, ovaries and pelvis
- a biopsy of tissue from the uterus
Based on your results your doctor may recommend further tests, such as hysteroscopy, where a small tube is inserted through your cervix to view the inside of your uterus. A procedure called dilation and curettage, which involves dilating the cervix to collect tissue from the uterus, may also be recommended.
How Is Menorrhagia Treated?
If you are diagnosed with menorrhagia, your doctors will consider some basic factors before deciding on a treatment plan that provides the best solution with minimal side effects. Factors to be considered include:
- medical history
- severity of the bleeding
- underlying reasons behind the bleeding
- your preference
There are a number of treatment options. Some are simple and others more complicated. Doctors will usually try the simplest methods of treatment first, and most women of childbearing age choose to manage heavy menstrual bleeding with medical therapies such as:
- iron supplements (if your condition is accompanied by anemia)
- anti-inflammatory medication such as ibuprofen or naproxen to help reduce blood loss and manage pain
- oral birth control to help regulate your menstrual cycle
- hormonal treatment such as oral progesterone, which can help correct hormonal imbalance and reduce blood loss
In rare cases of severe menorrhagia, certain surgical procedures may be done to reduce or stop the flow of menstrual blood entirely. Treatments such as endometrial resection (surgical removal of the lining of the uterus) or ablation (destruction of the uterine lining) reduce the bleeding and pain associated with menorrhagia, but can also reduce your ability to become pregnant.