Menstrual periods that are abnormally heavy or involve prolonged Bleeding are typically categorized as Menorrhagia. Menorrhagia is usually characterized by severe blood loss, which is much different than heavy menstrual bleeding (a common concern among women). Understanding and treating menorrhagia is an important part of improving the quality of life for any women regularly dealing with it.

Menorrhagia can become a major disturbance to everyday life and activities during a menstrual period due to the severe blood loss and cramping. Additionally, it may be a side effect of a much more serious condition. Fortunately, there are plenty of treatment options and procedures that can effectively treat menorrhagia. 

Symptoms

Generally, menorrhagia is characterized by severe, heavy bleeding during menstrual periods. Signs of menorrhagia include:

• Bleeding that lasts longer than a week 
• Heavy bleeding that leads to the need to change tampons or sanitary pads every hour for several consecutive hours
• Soaking more than 8 pads and/or tampons in a day
• Controlling menstrual flow with double sanitary protection
• Passing large blood clots (larger than a quarter) 
• Waking up to change sanitary protection throughout the night
• Restricting your life and activities during your period because of heavy flow
• Vaginal bleeding after menopause
• Irregular vaginal bleeding or bleeding between periods 
• Symptoms like fatigue, lightheadedness, dizziness, passing out or shortness of breath that may indicate anemia

What Causes Menorrhagia? 

There are a number of factors and conditions that can cause menorrhagia, though sometimes the reason may be unknown. Conditions vary in their severity, but common causes and conditions that may cause menorrhagia can include: 

• A hormone imbalance
• Uterine fibroids
• Endometrial Polyps
• An intrauterine device (IUD) for birth control
• General ovary dysfunction 
• Adenomyosis 
• Uterine cancer and cervical cancer
• Medications (anti-inflammatory, estrogen/progestin, anticoagulants)
• Inherited bleeding disorders (i.e. von Willebrand’s disease)
• Other medical conditions like liver or kidney disease.
• Complications with pregnancy (unusual location of placenta, possible miscarriage, etc.) 

Who’s at Risk? 

With such a wide array of conditions and causes for menorrhagia, risk factors can vary greatly. Age and the presence of other medical conditions that may explain your menorrhagia all play a role. 

During a normal menstrual cycle, the body’s production of progesterone is stimulated by the release of an egg from the ovaries. Progesterone is the hormone found in females that is most responsible for keeping periods regular. Insufficient progesterone can cause heavy menstrual bleeding when no egg is released. 

For this reason, adolescent girls who experience menorrhagia usually do because of anovulation (no egg being cyclically released from the ovary). In the first year after their first menstrual period, adolescent girls are more prone to anovulatory cycles.

Older women who are of reproductive age may experience menorrhagia due to uterine pathology like fibroids, adenomyosis, and polyps. These conditions are all quite common and easy to treat, however it’s important to rule out more serious issues like uterine cancer, liver or kidney disease, serious bleeding disorders and any side effects from medications. 

Complications from Menorrhagia

Severe and heavy bleeding anywhere in the body is not a good thing. Menorrhagia and any prolonged, excessive bleeding can lead to other serious medical conditions like anemia and severe menstrual cramps. 

Anemia is caused by a severe loss of blood that reduces the number of red blood cells circulating in the body. As your body uses your iron stores to make more hemoglobin (the protein that helps red blood cells carry oxygen to tissues), your body will suffer an iron deficiency which leads to anemia. 

Diet can play a role in your iron levels, but menorrhagia only complicates things further. Common anemia symptoms include pale skin, fatigue, lightheadedness, dizziness, shortness of breath, passing out spells and general weakness. 

Severe Pain

Additionally, extremely painful menstrual cramps called dysmenorrhea can occur alongside heavy menstrual bleeding. Medical attention and evaluation may be necessary for severe cramps associated with menorrhagia.

Diagnosing the Cause of Menorrhagia

If your menorrhagia symptoms are severe enough that you visit your doctor, ho or she will inquire about your medical history and typical menstrual cycles to get an idea of what may be the cause of your heavy bleeding. 

One method of understanding the severity and cause of menorrhagia may be through regularly recording your own bleeding days with specific notes about the severity of flow and amount of sanitary protection products needed to help control it. 

Other tests, procedures and a general physical exam can help your doctor get to the bottom of what’s causing menorrhagia. Common tests and procedures include: 

• Pap test – collecting cells from your cervix to test for inflammation, infection, or possible indications of cancer
• General blood tests – evaluate a sample of your blood for anemia, blood-clotting abnormalities, and thyroid problems. 
• Ultrasound and sonohysterogaphy – produce an image of the uterus, ovaries, and pelvis using sound waves to look for any abnormalities 
• Endometrial biopsy – a pathologist may examine a sample of tissue from your uterus 
• Hysteroscopy – examining the inside of your uterus using a thin, lighted instrument that passes through the vagina and cervix

These tests and examinations are used to help determine the cause of heavy bleeding. Once other medical conditions, menstrual disorders, or side effects of medications are ruled out, your doctor can be certain of a menorrhagia diagnosis.

Treating Menorrhagia

A number of factors can affect the specific treatment for menorrhagia. These include: 

• The underlying cause of menorrhagia
• Severity of symptoms
• General health and medical history
• Whether or not you plan to become pregnant 
• Personal tolerance to specific procedures and medications 
• How likely you are to start getting lighter periods

Medications

Once diagnosed, there are plenty of viable treatment options for menorrhagia. Medications and medical therapy for menorrhagia may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) – ibuprofen and its equivalents and naproxen sodium help relieve painful menstrual cramps and reduce general menstrual blood loss
• Oral progesterone – can reduce menorrhagia caused by hormone imbalance 
• Oral contraceptives (birth control) – can regulate menstrual cycles and reduce menorrhagia 
• Hormonal IUD – while some IUDs can be the cause of menorrhagia, others can be used to help decrease menstrual blood flow and cramping by thinning the uterine lining 
• Transexamic acid (Lysteda) – a medicine that helps reduce the activity of the body’s blood clot breakdown mechanisms. It is taken just durning the menstrual cycle and works about 50% of the time when no other identifiable bleeding causes are identified.

Hormone medication may also be a cause of menorrhagia. In that case, the condition may be treated by simply altering treatment or ceasing the medication altogether. Additionally, in cases where menorrhagia also causes anemia, you may need to take iron supplements to regulate your body’s hemoglobin levels. 

Surgeries 

In most cases, medication and medical therapy will be the first treatment option. But if they’re unsuccessful, surgical procedures may be a solution. Surgical treatment options for menorrhagia can include: 

• Uterine fibroid embolization
• Dilation and curettage (D&C)
• Myomectomy (removal of fibroids)
• Polypectomy (removal of polyps)
• Endometrial ablation or resection
• Hysterectomy

While surgery is always more serious than taking medications, and some of these specific procedures require a general anesthetic, many of them are completed on an outpatient basis or in your doctor’s office with oral sedation. 

Schedule a Consultation Today

If you’re dealing with severe or prolonged menstrual bleeding, you may be diagnosed with menorrhagia. Determining the cause of menorrhagia is the key to relieving symptoms and treating any other underlying conditions associated with heavy bleeding. 

Your Florida Woman Care of Jacksonville OB/GYN will assess you and any potential risk factors involved with menorrhagia and develop a unique treatment plan for you. If you’ve developed uncomfortable or disruptive symptoms and fear that menorrhagia could be the cause, schedule an appointment and let us help you determine the best course of action.

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