Menorrhagia refers to heavy or long menstrual flows. This condition may be accompanied by severe menstrual cramps, known as dysmenorrhea.
Untreated menorrhagia can lead to anemia (iron deficiency).
Menorrhagia can be caused by a variety of underlying conditions. You should always see a doctor about changes to your menstrual flow or if you are experiencing symptoms of menorrhagia.
Your doctor can determine if you have menorrhagia or metrorrhagia, another condition which causes heavy bleeding. Unlike menorrhagia which is heavy menstrual bleeding, metrorrhagia is spotting or heavy bleeding between periods. Some people have menometrorrhagia, a combination of both conditions.
Menorrhagia can be chronic or occasional. This condition has a wide range of potential causes.
Causes of menorrhagia include:
- IUD (intrauterine device) side effect
- uterine fibroids
- hormonal imbalance caused by conditions such as polycystic ovary syndrome (PCOS)
- menstrual cycles without ovulation (anovulation)
- ectopic pregnancy and other pregnancy complications
- uterine polyps
- medications, such as anticoagulants
- thyroid disease
- von Willebrand disease and other heritable bleeding disorders
- uterine (endometrial) cancer
- cervical cancer
- liver disease
- kidney disease
For many people who menstruate, an irregular cycle is normal. Sometimes a period may last longer or be heavier than it has been in previous months. Menorrhagia, however, differs from these normal variations in menstrual flow.
When you have menorrhagia, your periods are so heavy they interfere with daily life and normal activities. Symptoms may include:
- soaking through tampons or pads within one or two hours
- passing clots the size of quarters or larger
- a period that lasts for seven days or longer
- severe, very painful menstrual cramps
To diagnosis the cause of menorrhagia, a doctor will first ask about your menstrual and health history, including information about any contraception you use.
They may ask you to track your period and keep a symptoms diary that includes information about severity of menstrual flow, clotting, and cramping.
In some instances, an underlying cause will not be found. However, there are several tests that can help your doctor determine what’s causing menorrhagia. They include:
- Blood tests. These can be used to help your doctor gather information about your hormonal levels, thyroid function, or iron deficiency. They can also be used to identify problems with clotting or pregnancy.
- Transvaginal ultrasound. This test is used to look for uterine anomalies, such as fibroids, and ectopic pregnancy.
- Ultrasound of the uterus (saline contrast sonohysterography). This can be used to look for fibroids, polyps, and malignant lesions.
- Pap test. This can help your doctor identify cervical changes, including infection, inflammation, or cancer.
- Endometrial biopsy is used to check for abnormal tissue or cancer within the uterine lining.
- Hysteroscopy. If further testing is needed, this minimally invasive procedure may be done to further analyze the uterine lining and cavity. It is also done to retrieve a lost IUD.
- Liver function tests. If liver disease is suspected, a group of blood tests called liver function tests may be done. Imaging tests that look for liver damage may also be done.
- Tests for kidney disease. If kidney disease is suspected, a GFR blood testand urine test that checks for albumin may be done.
Your treatment will be determined by the underlying cause of your condition.
First line treatments for menorrhagia include:
- Birth control pills. These stop ovulation and may result in a lighter menstrual flow.
- Prostaglandin inhibitors (NSAIDs). These oral medications include over-the-counter ibuprofen and naproxen sodium. They can be used to reduce cramping and menstrual blood flow.
- Oral progesterone may help regulate hormone levels.
- Hormonal IUD. IUDs that release progestin thin out the uterine lining, which may reduce blood flow and cramping. Brand names include Mirena and Liletta.
- Tranexamic acid. This is an oral medication that promotes blood clotting, which may help slow the flow of blood.
Your doctor may also recommend iron supplements if blood loss has caused an iron deficiency.
When medical treatments don’t work, surgical treatments may be considered. They may include:
- D&C (dilation and curettage) to remove tissue from the uterine lining.
- Uterine artery embolization, which is used to shrink fibroids.
- Myomectomy, which is the surgical removal of fibroids.
- Endometrial ablation or endometrial resection. These procedures permanently destroy the uterine lining. They are only done in people who don’t plan to pursue pregnancy.
- Hysterectomy. This is the complete removal of the uterus. In some cases, the ovaries may also be removed. This procedure also eliminates the possibility of pregnancy.
At-home treatments won’t address the underlying cause of your condition, but they may help reduce blood flow and make you more comfortable. They can also help reduce the risk of anemia.
To treat menorrhagia symptoms at home, try taking over-the-counter NSAIDs and resting. Some people find that using a heating pad helps to alleviate pain and cramping.
Make sure to drink lots of water to remain hydrated. Blood loss can cause you to become dehydrated. If you are experiencing heavy bleeding, you may need to drink as much as 4 to 6 additional glasses of water a day. A daily electrolyte solution may also help reduce symptoms of dehydration.
Eating iron-rich foods can help reduce your risk for iron-deficiency anemia. These include liver, beef, and sardines. If you follow a vegetarian or vegan diet, lentils, spinach, and white beans are good plant-based sources of iron.
If you have a very heavy period for two months in a row, see a gynecologist or primary care doctor. Testing and can help your doctor identify any underlying causes and the best treatment options for you.
You should also see your doctor if:
- you have intense pain
- you’re passing many large clots
- you feel dizzy or faint
- you suspect you’re having a miscarriage or any type of medical emergency
Very heavy bleeding or severe pain can be signs of a medical emergency. If you feel faint or dizzy, see your doctor immediately.
If there is any chance you may be pregnant or having a miscarriage, seek medical attention right away.
Ectopic pregnancy can cause sharp, intense waves of pain in the stomach, pelvis, shoulder, or neck. This condition requires prompt medical attention to avoid rupture of a fallopian tube.
Menorrhagia refers to very heavy or overly long menstrual flows. This condition can refer to one menstrual cycle. It can also be chronic.
Menorrhagia has a wide range of potential causes. It can be the result of structural issues within the uterus or a hormonal imbalance. It can also be caused by several serious underlying health conditions.
Menorrhagia should always be assessed by a doctor. When heavy bleeding is accompanied by certain symptoms, such as feeling faint or having severe pain, immediate medical attention is warranted.