What is menorrhagia? Menorrhagia is the medical term for excessive menstrual bleeding. The bleeding can be excessively long, which means the bleeding lasts for more than seven days. It can also be excessively heavy menstrual bleeding. In general, this means you need to change a tampon or pad every two hours or you pass blood clots as big as a quarter or larger. Menorrhagia is a common problem for women in the United States. The Centers for Disease Control and Prevention (CDC) reports that it affects about 1 in 5 women. This means about 10 million American women have abnormally heavy or prolonged bleeding. Women can suffer with excessive menstrual bleeding when there are physical problems with the uterus. It can also happen when there are imbalances in the hormones that regulate a woman’s monthly cycle. Sometimes, another medical condition, such as a bleeding disorder, is responsible for the problem. However, doctors can’t find an underlying cause in about half the cases. Treating menorrhagia depends on whether there is an underlying cause or not. If so, treating any known cause may resolve the abnormal bleeding. Otherwise, hormonal medicines and surgical procedures can often alleviate the problem. Effective treatment can help correct complications, such as anemia. See your doctor before your next regular exam if you have excessive menstrual bleeding. See your doctor right away for any of the following: Any amount of vaginal bleeding after menopause or during pregnancy Irregular vaginal bleeding or spotting between periods Vaginal bleeding that requires changing a pad or tampon every hour for several hours in a row While excessive menstrual bleeding is not life threatening, it is sometimes a sign of a serious condition, such as cancer. What are the symptoms of menorrhagia? Excessive menstrual bleeding by itself can be a symptom of some other underlying problem. However, women can experience menorrhagia differently. Signs you may have menorrhagia include: Flow lasting longer than seven days Flow requiring you to double up on pads or use a pad and tampon together Flow that limits your daily activities and affects your quality of life Flow that requires you to change pads or tampons during the night Flow that soaks a pad or tampon every two hours Passage of clots the size of a quarter or bigger It’s common for women with menorrhagia to report pelvic pain or painful cramping that can also interfere with daily activities and quality of life. Heavy or prolonged bleeding can cause fatigue and lack of energy as well. If you have this type of bleeding on an ongoing basis, contact your doctor for an appointment before your regular exam. It’s important to find the underlying cause (if possible) and address it. In general, the earlier you seek a diagnosis for the causes of excessive bleeding, the better the outcome will be. What causes menorrhagia? Menorrhagia causes can be can broke out into three broad categories—uterine problems, hormonal problems, and other medical conditions. However, in about half the cases of excessive menstrual bleeding, there is no identifiable cause. Problems with the uterus Excessive menstrual bleeding can be the result of problems with the structure or function of the uterus. This includes: Adenomyosis, which is a problem with the uterine glands growing into the muscle of the uterus Cancer including cancer of the cervix and uterus Fibroids or polyps IUD (intrauterine device) birth control problems Pregnancy complications including ectopic pregnancy, unusual placenta location, and miscarriage Problems with hormones Estrogen and progesterone regulate ovulation and the monthly cycle that occurs around it. They work in balance with each other to promote the growth and shedding of the uterine lining. If they become imbalanced, the lining can become very thick. This leads to excessive bleeding when it is time to shed it. Conditions that can cause problems with hormone balance include: Anovulation, which is not releasing an egg during a menstrual cycle Insulin resistance Obesity PCOS (polycystic ovary syndrome) Thyroid disorders Other medical problems Other medical conditions can affect bleeding in general, which can lead to excessive menstrual bleeding. This includes: Bleeding disorders Blood cancers Liver or kidney disease Medications including NSAIDs (nonsteroidal anti-inflammatory drugs), anticoagulants, and aspirin What are the risk factors for menorrhagia? Outside of the causes of menorrhagia, there are no clear risk factors for developing it. Both young and older women of reproductive age can experience excessive bleeding. However, the causes are usually different. Younger women tend to have excessive bleeding from hormone-related causes, especially anovulation. Older women are more likely to have uterine-related causes, such as fibroids, during their reproductive years. Reducing your risk of menorrhagia It is not always possible to prevent or avoid menorrhagia because a cause is not always clear. You may be able to lower your risk by: Getting regular physical exercise Maintaining a healthy body weight Treating medical conditions that can contribute to excessive bleeding If you have any concerns about your menstrual period, talk with your doctor. Ask about your risk of developing menorrhagia. How is menorrhagia treated? Treatment of menorrhagia will depend on whether or not your doctor can identify an underlying cause. If so, treating the underlying cause may resolve the problem. When there is no clear cause, the two main treatment options are medications and surgery. The choice will depend on a variety of factors. This includes your age, your other medical conditions, and whether or not you plan to have children in the future. Medications The most common medications for treating menorrhagia are hormones. Oral contraceptives—either progesterone alone or a combination of estrogen and progesterone—are a frequent choice. They can regulate the menstrual cycle and help thin the uterine lining to decrease flow. Other forms of hormonal birth control, such as IUDs, can also be useful for balancing hormones and decreasing menstrual flow. Surgery There are various procedures to treat menorrhagia including: Dilation and curettage (D&C) opens the cervix to allow the doctor to scrape out the uterine lining. You may need to repeat this procedure in the future, as it is usually a temporary solution to excessive bleeding. Endometrial ablation uses cold, heat, laser, microwave or radiofrequency energy to permanently destroy the lining of the uterus. The goal is either no more monthly bleeding or very light periods. Endometrial resection uses an electrosurgical wire loop to remove the lining of the uterus. There is a high rate of women needing another procedure with this option. As a result, doctors tend to recommend other procedures. Hysterectomy removes the uterus and often the cervix. This is the definitive treatment for excessive menstrual bleeding as it removes the source of the problem. However, it is expensive, requires more recovery, and carries a higher risk of complications than the other options. Each woman’s situation is unique. Talk with your doctor to find the best option that fits your lifestyle. Take your time and ask about the risks and benefits of each option before making a final decision. Find out about the success rates your doctor has seen with each option. Also, make sure you understand all the implications for your future health, including cancer screening and detection and the possibility of needing a more invasive procedure in the future. What are the potential complications of menorrhagia? The main complication of menorrhagia is anemia due to blood loss. Warning signs of anemia include constant tiredness, fatigue, lack of energy, weakness, shortness of breath, pale skin, and feeling cold. Your doctor can check for anemia with a blood test. The test will measure hemoglobin, hematocrit, iron levels, and the size of your red blood cells. Hemoglobin is the protein your red blood cells use to carry oxygen to your tissues. Hematocrit tells your doctor the proportion of your blood that is made up of red blood cells. When any of these numbers are low, it may mean you have anemia. Prompt treatment of excessive bleeding can prevent complications, including anemia, and get you back to living your life.