Heavy Menstrual Bleeding

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Menorrhagia is menstrual bleeding that lasts more than 7 days. It can also be
bleeding that is very heavy. How do you know if you have heavy bleeding? If
you need to change your tampon or pad after less than 2 hours or you pass
clots the size of a quarter or larger, that is heavy bleeding. If you have this
type of bleeding, you should see a doctor.

Untreated heavy or prolonged bleeding can stop you from living your life to
the fullest. It also can cause anemia. Anemia is a common blood problem
that can leave you feeling tired or weak. If you have a bleeding problem, it
could lead to other health problems. Sometimes treatments, such as dilation
and curettage (D&C) or a hysterectomy, might be done when these
procedures could have been avoided.

Causes
Possible causes fall into the following three areas:

1. Uterine-related problems
 Growths or tumors of the uterus that are not cancer; these can
be called uterine fibroids or polyps.
 Cancer of the uterus or cervix.
 Certain types of birth control—for example, an intrauterine
device (IUD).
 Problems related to pregnancy, such as a miscarriage or ectopic
pregnancy, can cause abnormal bleeding. A miscarriage is when
an unborn baby (also called a fetus) dies in the uterus. An ectopic
pregnancy is when a baby starts to grow outside the womb
(uterus), which is not safe.
2. Hormone-related problems
3. Other illnesses or disorders
 Bleeding-related disorders, such as von Willebrand disease (VWD) or
platelet function disorder.
 Nonbleeding-related disorders such as liver, kidney, or thyroid
disease; pelvic inflammatory disease; and cancer.
In addition, certain drugs, such as aspirin, can cause increased bleeding.
Doctors have not been able to find the cause in half of all women who have
this problem. If you have bleeding such as this, and your gynecologist has not
found any problems during your routine visit, you should be tested for a
bleeding disorder.

View and print this chart [PDF – 675 KB]

Signs
You might have menorrhagia if you:

 Have a menstrual flow that soaks through one or more pads or

tampons every hour for several hours in a row.
 Need to double up on pads to control your menstrual flow.
 Need to change pads or tampons during the night.
 Have menstrual periods lasting more than 7 days.
 Have a menstrual flow with blood clots the size of a quarter or larger.
 Have a heavy menstrual flow that keeps you from doing the things you
would do normally.
 Have constant pain in the lower part of the stomach during your
periods.
 Are tired, lack energy, or are short of breath.
Diagnosis
Finding out if a woman has heavy menstrual bleeding often is not easy
because each person might think of “heavy bleeding” in a different way.
Usually, menstrual bleeding lasts about 4 to 5 days and the amount of blood
lost is small (2 to 3 tablespoons). However, women who have menorrhagia
usually bleed for more than 7 days and lose twice as much blood. If you have
bleeding that lasts longer than 7 days per period, or is so heavy that you
have to change your pad or tampon nearly every hour, you need to talk with
your doctor.

To find out if you have menorrhagia, your doctor will ask you about your
medical history and menstrual cycles.

He or she may ask you questions like the following:

 How old were you when you got your first period?
 How long is your menstrual cycle?
 How many days does your period usually last?
 How many days do you consider your period to be heavy?
 How do your periods affect your quality of life?
Your doctor may also ask if any of your family members have had heavy
menstrual bleeding. He or she may also have you complete this
questionnaire [PDF – 127 KB] to help determine if you need to be tested for a
possible bleeding disorder.
You might want to track your periods by writing down the dates of your
periods and how heavy you think your flow is (maybe by counting how many
pads or tampons you use). Do this before you visit the doctor so that you can
give the doctor as much information as possible. Above is a picture of a chart
that is used by some doctors to track your period. You can make your own
chart based on the one shown. Your doctor also will do a pelvic exam and
might tell you about other tests that can be done to help find out if you have
menorrhagia.
 Click here to view a larger image

Tests
Your doctor might tell you that one or more of the following tests will help
find out if you have a bleeding problem:

 Blood test. In this test, your blood will be taken using a needle. It will
then be looked at to check for anemia, problems with the thyroid, or
problems with the way the blood clots.
 Pap test. For this test, cells from your cervix are removed and then
looked at to find out if you have an infection, inflammation, or changes
in your cells that might be cancer or might cause cancer.
 Endometrial biopsy. Tissue samples are taken from the inside lining
of your uterus or “endometrium” to find out if you have cancer or other
abnormal cells. You might feel as if you were having a bad menstrual
cramp while this test is being done. But, it does not take long, and the
pain usually goes away when the test ends.
 Ultrasound. This is a painless test using sound waves and a computer
to show what your blood vessels, tissues, and organs look like. Your
doctor then can see how they are working and check your blood flow.
Using the results of these first tests, the doctor might recommend more
tests, including,
  Sonohysterogram. This ultrasound scan is done after fluid is injected
through a tube into the uterus by way of your vagina and cervix. This
lets your doctor look for problems in the lining of your uterus. Mild to
moderate cramping or pressure can be felt during this procedure.
 Hysteroscopy. This is a procedure to look at the inside of the uterus
using a tiny tool to see if you have fibroids, polyps, or other problems
that might be causing bleeding. You might be given drugs to put you to
sleep (this is known as “general anesthesia) or drugs simply to numb
the area being looked at (this is called “local anesthesia”).
 Dilation and Curettage (D&C). This is a procedure (or test) that can be
used to find and treat the cause of bleeding. During a D&C, the inside
lining of your uterus is scraped and looked at to see what might be
causing the bleeding. A D&C is a simple procedure. Most often it is
done in an operating room, but you will not have to stay in the hospital
afterwards. You might be given drugs to make you sleep during the
procedure, or you might be given something that will numb only the
area to be worked on.
Treatment
The type of treatment you get will depend on the cause of your bleeding and
how serious it is. Your doctor also will look at things such as your age,
general health, and medical history; how well you respond to certain
medicines, procedures, or therapies; and your wants and needs. For
example, some women do not want to have a period, some want to know
when they can usually expect to have their period, and some want just to
reduce the amount of bleeding. Some women want to make sure they can
still have children in the future. Others want to lessen the pain more than
they want to reduce the amount of bleeding. Some treatments are ongoing
and others are done one time. You should discuss all of your options with
your doctor to decide which is best for you. Following is a list of the more
common treatments.

Drug Therapy

 Iron supplements. To get more iron into your blood to help it carry
oxygen if you show signs of anemia.
  Ibuprofen (Advil). To help reduce pain, menstrual cramps, and the
amount of bleeding. In some women, NSAIDS can increase the risk of
bleeding.
 Birth control pills. To help make periods more regular and reduce the
amount of bleeding.
 Intrauterine contraception (IUC). To help make periods more regular
and reduce the amount of bleeding through drug-releasing devices
placed into the uterus.
 Hormone therapy (drugs that contain estrogen and/or
progesterone). To reduce the amount of bleeding.
 Desmopressin Nasal Spray (Stimate®). To stop bleeding in people
who have certain bleeding disorders, such as von Willebrand disease
and mild hemophilia, by releasing a clotting protein or “factor”, stored
in the lining of the blood vessels that helps the blood to clot and
temporarily increasing the level of these proteins in the blood.
 Antifibrinolytic medicines (tranexamic acid, aminocaproic acid). To
reduce the amount of bleeding by stopping a clot from breaking down
once it has formed.
Surgical Treatment

 Dilation and Curettage (D&C). A procedure in which the top layer of

the uterus lining is removed to reduce menstrual bleeding. This
procedure might need to be repeated over time.
 Operative hysteroscopy. A surgical procedure, using a special tool to
view the inside of the uterus, that can be used to help remove polyps
and fibroids, correct abnormalities of the uterus, and remove the lining
of the uterus to manage heavy menstrual flow.
 Endometrial ablation or resection. Two types of surgical procedures
using different techniques in which all or part of the lining of the uterus
is removed to control menstrual bleeding. While some patients will
stop having menstrual periods altogether, others may continue to have
periods but the menstrual flow will be lighter than before. Although the
procedures do not remove the uterus, they will prevent women from
having children in the future.
 Hysterectomy. A major operation requiring hospitalization that
involves surgically removing the entire uterus. After having this
 procedure, a woman can no longer become pregnant and will stop
having her period.
Menorrhagia is common among women. But, many women do not know that
they can get help for it. Others do not get help because they are too
embarrassed to talk with a doctor about their problem. Talking openly with
your doctor is very important in making sure you are diagnosed properly and
get the right treatment.

Who is Affected
Heavy bleeding (menorrhagia) is one of the most common problems women
report to their doctors. It affects more than 10 million American women each
year. This means that about one out of every five women has it.

References

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Resource Center (NWHRC), Washington,
D.C. http://www.healthywomen.org.
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http://preventdisease.com/diseases/menstruation_heavy_bleeding.htm
l.
3. Women with Inherited Bleeding Disorders: Surgical Options for
Menorrhagia. Canadian Hemophilia Society. http://www.hemophilia.ca.
4. Menorrhagia (heavy menstrual bleeding). CNN.com.
http://www.cnn.com/HEALTH/library/DS/00394.html.
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Bachmann G. Development of a screening tool for identifying women
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menorrhagia. American Family Physician 2007;75:1813–1819,1820.
http://www.aafp.org/afp/20070615/1813.html.
7. Heavy Bleeding and Endometrial Ablation. FertilityAnswers.com.
http://www.fertilityanswers.com/endometrial_ablation.htm.
8. Menorrhagia (heavy menstrual bleeding). MayoClinic.com Health
Library. http://www.riverside-online.com/health_reference/Womens-Health/
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 National Collaborating Centre for Women’s and Children’s Health.
National Institute for Health and Clinical Excellence (NICE). Heavy
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