Heavy Menstrual Bleeding

Menorrhagia is the medical term for heavy menstrual periods.  The medical definition of menorrhagia is blood loss that exceeds 80 mL per menstrual cycle.  Since it can be difficult to measure blood loss volume, other standards are typically used to diagnose heavy periods:

• Passing blood clots the size of quarters or larger
• Saturating one or more tampons or sanitary pads an hour for multiple consecutive hours
• Menstrual bleeding lasting longer than seven days
• Symptoms of anemia, such as fatigue and shortness of breath

What causes heavy periods?

Menorrhagia has many possible causes:

• Uterine fibroids or polyps: the most common cause of menstrual disorders, these benign growths of the uterus or on the lining of the uterus may cause heavy periods
• Hormonal imbalances: results in excess endometrial development, which is then shed with heavy menstrual bleeding
• Intrauterine device (IUD): menorrhagia is a known side-effect of non-hormonal or copper IUDs
• Pregnancy Complications: miscarriage and ectopic pregnancies can cause acute heavy bleeding
• Other medical conditions: inherited blood clotting disorders and some cancers may cause excessive menstrual bleeding

Diagnosing heavy periods

Abnormally heavy menstrual bleeding can be difficult to diagnose because it can be subjective.  Diagnostic tools and tests include:

• Tracking the duration, number of tampons/sanitary pads soaked, and presence of clots during menstruation
• Pap tests to check for inflammation, infection, or cancerous cells
• Blood tests are recommended to look for blood-clotting and thyroid disorders
• Ultrasounds are used to view the uterus, ovaries, and fallopian tubes
• Additional medical tests that may be recommended include endometrial biopsy, sonohysterogram, and hysteroscopy to look for problems with the uterine lining

Treating menorrhagia

Treatment options may include:

• Birth control or hormone therapy
• Anti-inflammatories
• Iron supplements
• Surgery

In cases where surgical treatment is required, a consultation with your gynecologist is recommended. This includes dilation and curettage (D&C), endometrial resection, or endometrial ablation to remove the endometrial lining and reduce menstrual flow. Hysterectomy is the most definitive treatment for women who have heavy periods.