A health condition in which females experience heavy menstrual bleeding is called menorrhagia. It is considered a person has this condition if periods are heavy and last more than several days. However, it is a common concern among women but most of them do not have enough blood loss to be diagnosed with this condition.
In some cases, women experience bleeding between periods either before or after is expected. Thus, doctors call this bleeding type abnormal uterine bleeding or irregular menstrual bleeding.
Heavy menstrual bleeding can interfere with your daily routine. In any case, consult with your healthcare professional if you dread this condition because there are different treatments available.
Symptoms
Check below some symptoms that usually occur in people with heavy menstrual bleeding:
- Using sanitary pads or tampons every hour
- To control menstrual flow you will need double sanitary protection
- Changing the sanitary pads or tampons during nighttime
- Bleeding lasts more than 7 days
- Extreme tiredness
- Shortness of breath
- Blood clots larger than a quarter
- Unable to perform different daily activities due to heavy menstrual flow
It is advised to visit a doctor immediately if any of the following symptoms happen. For example:
- Vaginal bleeding after menopause
- Bleeding occurs between menstrual periods
- heavy menstrual bleeding as you change one pad or tampon every hour
Causes
While there are different causes of heavy menstrual bleeding, sometimes, the cause cannot be identified. Check below some menorrhagia causes:
Hormonal Imbalance
Generally, when a person is healthy there is a balance between hormones (such as Estrogen and Progesterone). As a result, hormonal balance keeps under control the endometrium (the lining of the uterus) that is shed during menstrual periods. In case a hormonal imbalance happens, the lining may become too thick and cause heavy menstrual bleeding or unusual bleeding between menstrual periods. In addition, polycystic ovary syndrome (PCOS), obesity, insulin resistance, and thyroid conditions are some health problems that usually cause hormonal imbalances.
Issues with Ovaries
Some women may experience anovulation (when ovaries do not release eggs during periods). In such cases, Progesterone levels decrease causing a hormonal imbalance and heavy menstrual periods.
Uterine Fibroids
Commonly, fibroids (tumors) develop during childbearing years. In most cases, these fibroids are benign (noncancerous) but can cause heavy menstrual periods or prolonged bleeding.
Polyps
Polyps are small growths that may appear on the lining of the uterus. These growths can cause heavy menstrual periods, or unexpected bleeding that occur between periods. It also may lead to spotting or bleeding after menopause. In most cases, polyps are not malignant (cancerous).
Adenomyosis
This is a health condition in which the uterus lining begins to grow into the uterus wall itself. As a result, heavy and painful menstrual periods can occur.
Intrauterine Device
It is common for people who use an intrauterine device (also known as IUD) to experience heavy menstrual bleeding. It occurs as an adverse reaction to using this device. Discuss with your healthcare provider about other birth control methods if you are concerned about this side effect.
Pregnancy Complications
Sometimes, heavy periods happen due to a miscarriage. However, there are other pregnancy complications that cause heavy menstrual bleeding including abnormal location of the placenta, ectopic pregnancy, and others.
Cancer
Heavy uterine bleeding also can happen due to cancer of the uterus or cervix. Previous cancer types can happen either before or after menopause. One factor that increases the risk of cervical cancer is an abnormal Pap test in the past.
Genetic Bleeding Disorders
There are some genetic bleeding disorders that commonly run in families. These disorders are one of the multiple causes of heavy menstrual bleeding. For instance, von Willebrand’s disease is a genetic disorder that makes blood not clot properly.
Medications
There are different medications that cause heavy or long-lasting menstrual bleeding. For example, medications that contain Estrogen and Progestin (birth control pills) and drugs used to prevent blood clots also can provoke heavy menstrual bleeding. These include Warfarin, Enoxaparin, Apixaban, and Rivaroxaban. In addition, birth control medications are usually used to lessen menstrual bleeding but sometimes, unusual bleeding between periods can occur.
Other Health Conditions
The following conditions can cause heavy menstrual bleeding. For example kidney, thyroid, and liver disease, and many others. Discuss with your healthcare professional for more details.
Risk Factors
The risk factors for heavy menstrual bleeding are different depending on the age and existing health problems. In most cases, unexpected bleeding between periods and heavy menstrual bleeding happens due to reduced production of Progesterone that happens because the egg is not released by the ovaries.
Irregular or heavy menstrual bleeding can occur in teenagers also because the egg is released during a monthly cycle. Furthermore, teenagers are more prone to experience irregular menstrual periods within the first year they had their first menstrual periods.
However older women of reproductive age experience usually heavy menstrual bleeding due to uterus problems caused by certain health conditions including fibroids, polyps, and adenomyosis. Moreover, other conditions also can cause heavy menstrual bleeding including uterus cancer, bleeding disorders, adverse effects of medications, kidney or liver disease, and others.
Complications
Women who experience heavy menstrual bleeding or periods that last too long can experience the following complications. For example:
- Anemia – This is a health condition in which the amount of red blood cells is reduced. In such cases, low red blood cell count is associated with blood loss.Sometimes, iron deficiency anemia can occur. It usually happens when the body tries to make red blood cells instead of lost ones. However, heavy menstrual bleeding may reduce the amount of iron in the blood leading to this anemia type. In addition, tiredness and headaches are the most common anemia symptoms.
- Severe pain – Some women with heavy menstrual bleeding may also experience painful menstrual cramps that often happen at the same time. If the pain is as severe as it interacts with your daily routine, it is advised to consult with your healthcare professional for pain relievers.
Diagnosis
Doctors usually ask some questions about menstrual cycles and medical history. They can also recommend keeping a diary to track days with and without bleeding. Thereafter, physicians may perform some additional tests to find the exact cause of heavy menstrual bleeding. Examples include:
- Blood tests – These tests are often done to check for iron deficiency anemia as well as other conditions (including blood clotting problems, thyroid conditions, and others).
- Pap test – During this test, doctors collect certain cells from the cervix and check them for inflammation or changes (that may be precancerous). They also test them for human papillomavirus, especially females between 25-30 years old.
- Endometrial biopsy – During this test doctors will take a small sample of the uterus and send it to the laboratory for testing. This test usually helps to identify cancer symptoms or precancer of the uterus.
- Ultrasound – This is a special test that uses sound waves to produce detailed images of the ovaries, pelvis, and uterus.
According to results from previous tests, doctors may perform additional ones. These include:
- Sonohysterography – This test involves a special tube that helps to inject some fluid into the cervix. Thereafter, doctors perform an ultrasound test to check for problems.
- Hysteroscopy – This is a test in which doctors use a special instrument to see inside the uterus.
Usually, doctors confirm heavy menstrual bleeding when they determine the exact cause of this health problem.
Treatment
The treatment that doctors prescribe for the patients is different because it depends on several factors. For example:
- Medical history and overall health
- Underlying conditions and their severity
- Your tolerance to some medications and procedures
- Chances to lessen heavy periods
- Plans to become pregnant
- Lifestyle habits
- Personal choices and opinion
Medications
The following medicines are commonly recommended by doctors for people with heavy menstrual bleeding. Examples include:
- Tranexamic acid – This is a medicine used to reduce blood loss during periods.
- Oral contraceptives – This group of medicines can be used to regulate menstrual cycles and lessen bleeding during periods.
- Oral Progesterone – This medicine contains Progesterone that helps to balance hormones during menstrual periods and lessen heavy bleeding.
- Hormonal IUD – This is a special device used to get a type of Progestin (man-made Progesterone) called Levonorgestrel. It helps to reduce cramps and menstrual flow.
- Other medications – Doctors may also prescribe other medicines to control heavy uterine bleeding. These include gonadotropin-releasing hormone agonists, antagonists (GnRH) medicines, Estrogen, and others.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) – These medicines are used to lessen pain and cramps caused by heavy menstrual bleeding. For example Ibuprofen, Naproxen sodium, Aspirin, and others.
Healthcare providers may also recommend iron supplements if the levels are reduced despite you do not have iron deficiency anemia.
Procedures
Some people require surgery to treat heavy menstrual bleeding. For example:
- Dilation and curettage (D&C) – During this procedure, physicians open the cervix (also called dilating the cervix) and scrape or suction tissue from the uterus lining (curettage). Doctors usually recommend this procedure if the cause of heavy menstrual bleeding is polyps, fibroids, or uterus cancer. Sometimes, D&C can be used to empty the uterus in people who have had a miscarriage.
- Uterine artery embolization – This treatment option is used to block blood flow to fibroids, which helps to shrink them.
- Focused ultrasound – This is a special procedure used to destroy fibroids without incisions.
- Myomectomy – This surgery is used to remove uterine fibroids. Sometimes, fibroids are removed through a few small incisions in the abdomen but it depends on their size and location.
- Endometrial ablation – The surgeon uses a laser, radio waves, or heat to destroy the uterus lining. In addition, you should not become pregnant after this procedure because it may be dangerous.
- Endometrial resection – During this procedure, surgeons will remove the lining of the uterus using an electrosurgical wire loop. Do not become pregnant after this procedure.
- Hysterectomy – This is a surgery in which the uterus and cervix are removed. However, it ends menstrual periods and the ability to become pregnant.
Frequently Asked Questions
Are there home remedies for people with heavy menstrual bleeding?
Yes, the following tips can help lessen heavy bleeding and pain. For example:
- Include in your diet more foods rich in iron and vitamin C
- Stay hydrated
- Apply a heat pad
- Regular exercise and rest
- You also can use a menstrual cap or wear period pants during nighttime
What is the most common cause of heavy menstrual bleeding?
Most women experience heavy menstrual bleeding due to hormonal imbalances that make the uterus lining too thick. Thus, the following health problems can cause a hormonal imbalance such as obesity, insulin resistance, polycystic ovary syndrome (PCOS), thyroid diseases, and others. For more details, discuss it with your healthcare professional.
What is the primary medicine prescribed for people with heavy menstrual bleeding?
Doctors usually recommend Tranexamic acid because it helps reduce heavy bleeding and the length of the menstrual cycle. Ask your healthcare professional if you have additional questions.
