During your menstrual cycle, if an egg is not fertilized, the uterine lining breaks down, and bleeds. The egg and the uterine lining are then shed during your period.
Hormone problems or conditions that affect the uterus can result in heavy bleeding. Other diseases or bleeding disorders can also cause it.
Hormone problems include:
- Imbalance of estrogen and progesterone or other hormones
Problems with the uterus include:
- Fibroids (non cancerous)
- Pregnancy problems (such as a miscarriage or ectopic pregnancy)
- Use of an intrauterine device (IUD)
Other conditions such as thyroid, kidney or liver disease, cancer or bleeding disorders can also cause heavy bleeding.
If you have to change your pad or tampon every 1 to 2 hours because it is soaked, or bleed longer than 7 days, see your doctor. Spotting or bleeding between periods is also a sign of a problem.
The symptoms of menorrhagia may look like other conditions or medical problems. Always consult your healthcare provider for a diagnosis.
Your healthcare provider will ask you about your medical history and about your periods. You will also have a physical exam including a pelvic exam. You may be asked to keep track of your periods and how many pads or tampons you use for a few months if you haven’t already done so.
- Blood tests. These check for anemia and test how fast your blood clots.
- Pap test. For this test, cells are collected from the cervix and examined. It’s used to check for cancerous changes, infection, or inflammation.
- Ultrasound. Using sound waves and a computer, your healthcare provider can check for fibroids or other problems inside the uterus.
- Biopsy. Examining a tissue sample from the uterine lining can help your healthcare provider find cancer or other abnormal tissue.
Other tests include:
- Hysteroscopy. Using a viewing instrument inserted through the vagina, your healthcare provider can see the cervix and the inside of the uterus.
- Dilation and curettage (D&C).This procedure involves scraping and then examining the uterine cavity.
Your healthcare provider will consider your age and overall health and your personal preferences when finding the best treatment for you.
Treatment for hormone problems may include:
- Prostaglandin inhibitors. These are nonsteroidal anti-inflammatory medicines (NSAIDs), including aspirin or ibuprofen. They help reduce cramping and the amount you bleed.
- Birth control pills. These stop ovulation and result in lighter periods.
- Progesterone. This is a type of hormone treatment.
Treatment for problems with the uterine lining (endometrium) may include:
- Ablation. Healthcare providers use this procedure to destroy the lining of the uterus (endometrium).
- Resection. In this procedure, the lining of the uterus is removed.
- Hysterectomy. This is the surgical removal of the whole uterus.
- Iron supplements. If you have anemia as a result of the heavy loss of blood, you may need iron supplements.
- You have to change your pad or tampon every 1 to 2 hours because it is soaked
- Bleed longer than 7 days
- Have spotting or bleeding between periods
- Menorrhagia is heavy or prolonged menstrual bleeding. It is a common problem in women.
- It is caused by hormone problems, problems with the uterus, or other health conditions.
- Menorrhagia is diagnosed with a pelvic exam, ultrasound, pap test, and sometimes a biopsy.
- Treatment includes hormones, or other medicine, or procedures to treat the uterine lining or remove the uterus.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
April 24, 2018
Apgar, BS. Treatment of Menorrhagia. American Family Physician. (2007); 75(12); pp. 1813-1819, American College of Obstetricians and Gynecologists. Dysmenorrhea http://www.acog.org/~/media/For%20Patients/faq046.pdf?dmc=1&ts=20121213T0932062648, Differential diagnosis of genital tract bleeding in women. UpToDate., Abnormal uterine bleeding in adolescents: Definition and evaluation. UpToDate., Abnormal uterine bleeding in adolescents: Management. UpToDate., Abnormal uterine bleeding in adolescents: Differential diagnosis and approach. UpToDate., Management of abnormal uterine bleeding. UpToDate., Approach to abnormal uterine bleeding in nonpregnant reproductive-age women. UpToDate.
Burd, Irina, MD, PhD,Freeborn, Donna, PhD, CNM, FNP