Heavy Menstrual Bleeding

(Menorrhagia; Hypermenorrhea)

Definition

Heavy menstrual bleeding (also called menorrhagia) is excessive menstrual blood loss that interferes with a woman's quality of life.

Menstrual Flow

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Causes    TOP

In some cases, the cause is not known. However, many conditions have been associated with menorrhagia, such as:

Risk Factors    TOP

Factors that may increase your chances of menorrhagia include:

Symptoms    TOP

Symptoms of menorrhagia include:

  • Menstrual bleeding lasting more than seven days
  • Unusually heavy bleeding (soaking through a sanitary napkin or tampon every hour)
  • Menstrual flow requiring change of sanitary protection during the night
  • Menstrual flow including large clots
  • Menstrual flow interfering with lifestyle
  • Fatigue and/or shortness of breath (symptoms of anemia)

When Should I Call My Doctor?

Call your doctor if you have symptoms of menorrhagia.

Diagnosis    TOP

Your doctor will ask about your symptoms and medical history. A physical examination, including a pelvic exam, will be done. Tests may include:

Treatment    TOP

Treatment depends on the underlying cause of the heavy menstrual bleeding. Your doctor will work with you to create a treatment plan.

Medications

Your doctor may recommend:

  • Hormonal therapy
  • An IUD that releases the hormone progesterone
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Iron supplement

Surgical Procedures

In some cases, surgery may be needed, such as:

  • Dilation and curettage
  • Operative hysteroscopy—may be used along with other tools to remove a polyp
  • Removal of the lining of the uterus—endometrial ablation
  • Removal of the uterus—hysterectomy

Prevention    TOP

There are no current guidelines to prevent heavy menstrual bleeding.

RESOURCES:

Office on Women's Health
http://www.womenshealth.gov/
The American Congress of Obstetricians and Gynecologists
http://www.acog.org/Patients

CANADIAN RESOURCES:

The Canadian Women's Health Network
http://www.cwhn.ca/
The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org/

References:

Apgar B, Kaufman A, et al. Treatment of menorrhagia. Am Fam Physician. 2007;75(12):1813-1819.
Heavy menstrual bleeding. EBSCO DynaMed website. Available at:
...(Click grey area to select URL)
Updated November 7, 2013. Accessed August 18, 2014.
Menorrhagia (heavy menstrual bleeding). Mayo Clinic website. Available at:
...(Click grey area to select URL)
Updated July 2, 2014. Accessed August 18, 2014.
11/20/2009 DynaMed's Systematic Literature Surveillance
...(Click grey area to select URL)
FDA approves Lysteda to treat heavy menstrual bleeding. United States Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm190551.htm. Updated April 16, 2013. Accessed August 18, 2014.
Last reviewed August 2014 by Andrea Chisholm, MD
Last Updated: 09/30/2013
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