Menorrhagia

Causes of menorrhagia

If an egg is not fertilized during your menstrual cycle, the lining of the uterus will break down and shed off and out through the vagina. In some women, the endometrium builds up in excess and the shedding causes very heavy bleeding.

The most common cause of menorrhagia is hormonal issues or imbalances that could be caused by a condition such as polycystic ovary syndrome.

Menorrhagia can also be caused by other conditions such as:

• Uterine polyps – uterine polyps are benign but can cause heavy bleeding
• Women with uterine or cervical cancer
• Ectopic pregnancy or miscarriage – typically an ectopic pregnancy or miscarriage will cause heavy bleeding in a single event
• Inherited bleeding disorders
• Medications – such as hormone medicines, anticoagulants or anti-inflammatory medications can lead to heavy, prolonged bleeding
• Non-cancerous uterine fibroids
• IUD (intrauterine device) usage
• Thyroid conditions
• Kidney conditions
• Liver disease

Risks factors for menorrhagia

Risk factors may include:

• Insufficient progesterone – if an egg is not released during your menstruation cycle, your body will not produce progesterone, which can lead to heavy bleeding
• Anovulation (egg is not released)  – younger girls are at higher risk of anovulation during the first year of their period
• Taking certain medications – some medications can cause heavy bleeding as a side effect

If you have any of the following conditions, you are more likely to experience heavy, prolonged bleeding during your period:

• Fibroids
• Uterine cancer
• Bleeding disorders
• Liver or kidney disease

Symptoms of menorrhagia

If you have menorrhagia, the bleeding is so severe that you cannot continue with your day-to-day activities because you have so much blood loss and cramping.

Additional symptoms of menorrhagia include:

• Bleeding through your tampon or pad every hour for a few consecutive hours
• Experiencing consistent bleeding for longer than seven days
• Spotting or bleeding between periods
• Passing large blood clots that are bigger than a silver dollar
• Experiencing tiredness, fatigue or shortness of breath
• Waking up at night to change your sanitary napkin or tampon

Your symptoms may indicate you have another underlying condition, schedule an appointment with your doctor to ensure you are accurately diagnosed.

Diagnosis of menorrhagia

Although many women experience heavy flow days during their menstrual cycle, most do not lose enough blood to be diagnosed with menorrhagia.

Your doctor will be able to diagnose menorrhagia during an office visit. During the appointment, your doctor will take a full medical history, perform a pelvic exam and evaluate your symptoms. Your doctor may ask you to closely track your periods and the number of sanitary napkins or tampons you use during each cycle.

Other tests or procedures that may be used to diagnose menorrhagia include:

• Blood tests – a blood test can evaluate how quickly your blood clots as well as check for anemia
• Pap test – pap test (pap smear) can evaluate your tissue for cancerous cells, infection or inflammation
• Ultrasound – an ultrasound can identify fibroids, polyps or any other growths in the uterus
• Endometrial biopsy – a sample of uterine lining tissue can be evaluated for cancer
• Hysteroscopy – allows your doctor to view the uterus and cervix by inserting a thin tube inside the body

Treatment of menorrhagia

Your doctor will take into consideration your overall health, what is causing your condition and your age as he or she develops a treatment plan for you.

If hormone imbalances are causing your menorrhagia, medical management is typically a first-line treatment option. Medication treatments for menorrhagia may include:

• Prostaglandin inhibitors – nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen can reduce pain, cramping and reduce blood loss
• Oral contraceptives (birth control pills) – birth control pills stop ovulation, so your period is lighter
• Oral progesterone – progesterone can help correct a hormonal imbalance and reduce your bleeding
• Hormonal IUD – a hormonal intrauterine device (IUD) may help regulate your hormones, thin out the uterine lining and decrease menstrual blood flow and cramping

If you have a uterine lining issue and medical management has not been effective, surgical treatment may be necessary. Surgical treatment options may include:

• Endometrial ablation – Your doctor may perform an ablation to destroy the endometrium (uterine lining)
• Endometrial resection – During an endometrial resection, the lining of the uterus is removed with a wire loop. This procedure should only be performed on women who no longer desire to have children.
• Hysterectomy – In severe cases, a hysterectomy may be the only option. During a hysterectomy, the entire uterus (and sometimes the ovaries) are removed.
• Dilation and curettage (D&C) – During a D&C, your doctor will dilate your cervix and scrape excess tissue from the uterus lining.
• Uterine artery embolization – A uterine artery embolization helps shrink fibroids in the uterus by cutting off blood supply to the fibroids. During the procedure, your doctor will inject materials into the uterine arteries to decrease blood flow to the fibroid.
• Ultrasound surgery – Ultrasound surgery shrink the fibroids using focused ultrasound waves to destroy the fibroid tissue.