Menometrorrhagia

What is menometrorrhagia?

Menometrorrhagia (also called abnormal uterine bleeding) is any vaginal bleeding that is heavy, long or irregular. It’s when you bleed from your vagina, but the bleeding doesn’t follow a predictable pattern like a typical menstrual period. A typical period lasts about five days and occurs every 21 to 35 days. Any bleeding that occurs outside of menstruation or a period that is very long or heavy or irregular may be a sign of menometrorrhagia.

Having unpredictable bleeding can be frustrating. Not knowing when you’ll bleed, how much you’ll bleed or how long you’ll bleed can negatively affect your quality of life. It may make you want to stay home or cancel plans you were looking forward to. But it doesn’t have to be this way. Bleeding unexpectedly isn’t something you should just accept.

Your healthcare provider should know about any abnormal bleeding you’re experiencing, especially when it affects your physical and emotional health. What’s causing your bleeding may be harmless. But irregular bleeding could also be a sign of a health condition that could impact your fertility or have other long-term health complications.

What is the difference between menorrhagia and menometrorrhagia?

Menorrhagia is heavy menstrual bleeding. This means you bleed too much during your period.

Menometrorrhagia is abnormal, unpredictable or irregular uterine bleeding that occurs at any time, not just during menstruation.

How common is menometrorrhagia?

Not everyone who experiences abnormal uterine bleeding reports their symptoms. As a result, 10% to 35% of people with a uterus may have abnormal uterine bleeding. But the numbers may be higher. It’s most common in perimenopause (the years leading up to menopause), but also common when you first begin having a period (around age 12).

What are signs of menometrorrhagia?

The signs of menometrorrhagia vary depending on the cause. Most healthcare providers consider abnormal bleeding to be anything other than bleeding for about five days every 21 to 35 days. If you never know when you’re going to bleed, how much you’ll bleed or for how long, you may have menometrorrhagia.

Some specific signs that your bleeding may be abnormal include:

• Heavy menstrual bleeding (menorrhagia). Signs of heavy bleeding include soaking through pads or tampons every hour for several hours or needing to double-up on pads and tampons.
• Bleeding or spotting anytime between menstrual periods. (Or bleeding anytime you’re not on your period.)
• Unusually long periods (periods lasting longer than seven days).
• Inconsistent or unpredictable menstrual cycles. Your cycles occur fewer than 21 or more than 35 days apart and often vary from one cycle to the next.
• Not having a period for longer than three months.
• Bleeding after menopause.
• Feeling tired or weak, which are signs of anemia. You can get anemia from losing too much blood.

What causes menometrorrhagia?

Hormonal issues, noncancerous growths, cancer, infections, other medical conditions and medications can cause abnormal uterine bleeding. Only your healthcare provider can determine what’s causing you to bleed irregularly. There are many possible causes, so it’s best to talk to a provider about your symptoms so they can figure out what’s going on.

Hormonal disorders

Hormone imbalances are often to blame for abnormal uterine bleeding. They’re most common among people whose periods are just beginning or and in people whose periods are about to stop because of menopause. Your hormones are responsible for your menstrual cycle. Like a symphony orchestra, your hormones need to play in perfect harmony for menstruation to occur exactly how it should. Any disruption to the balance of your hormones can cause abnormal uterine bleeding. Some of these disruptions include:

• Anovulation
• Thyroid disease
• Polycystic ovary syndrome (PCOS)
• Obesity; weighing more than what’s ideal for your body can cause hormonal imbalances
• Stress

Noncancerous growths

Benign (noncancerous) growths in your uterus can create blockages or bleed themselves, depending on what kind of growth it is. Some examples are:

• Polyps
• Fibroids
• Adenomyosis
• Endometriosis

Precancer and cancer

Rarely, certain cancers are the cause of menometrorrhagia. These include:

• Uterine cancer
• Cervical cancer
• Vaginal cancer
• Ovarian cancer
• Endometrial hyperplasia

Infections

Sexually transmitted infections (STIs) and infections you don’t get through sex can cause irregular bleeding. The following may be the cause of menometrorrhagia:

• Trichomoniasis
• Cervicitis
• Pelvic inflammatory disease (PID)
• Chlamydia
• Gonorrhea
• Endometritis
• Vaginitis

Other medical conditions

Other medical conditions or events can be a factor in abnormal uterine bleeding. Some examples of health conditions that could cause menometrorrhagia are:

• Liver disease
• Kidney disease
• Von Willebrand disease
• Blood clotting disorders
• Pregnancy
• Miscarriage
• Ectopic pregnancy
• Injuries to your uterus due to trauma (like a car accident)

Always contact your provider if you bleed during pregnancy. It could be a sign of a pregnancy complication.

Medications

Certain medications can cause irregular uterine bleeding. (Ironically, some of these medications can also help treat irregular bleeding.) Always tell your provider what medications you take so they can rule out medication being a cause.

• Blood thinners and aspirin
• Hormone replacement therapy (HRT)
• Tamoxifen (breast cancer drug)
• Intrauterine devices (IUDs); forgetting to remove an IUD can also lead to infection and abnormal bleeding
• Certain types of birth control

Who does menometrorrhagia affect?

The term “abnormal uterine bleeding” describes bleeding in nonpregnant people in their reproductive years. But this doesn’t mean that irregular bleeding won’t affect you if you’re post-menopausal or pregnant. Almost anyone with a uterus can experience abnormal bleeding. In fact, the chances are high that you’ll experience it at some point in your life. Even so, most cases of irregular bleeding aren’t serious and get better with the right treatment.

If you’re bleeding and have transitioned to menopause, contact a healthcare provider. Bleeding after menopause is never normal. Blood may be red, pink, brown or even rust-like in appearance.

You should also contact your provider if you’re bleeding during pregnancy. Some causes are harmless, but others require medical attention.

What are the complications of menometrorrhagia?

Abnormal uterine bleeding isn’t life-threatening, but it can lead to anemia. Anemia happens when your blood doesn’t have enough healthy red blood cells. It can leave you feeling weak and sluggish.

Irregular bleeding can also be a sign of certain cancers and other medical conditions. Because you don’t know what’s causing irregular uterine bleeding, you should seek care from a healthcare provider to avoid these and other complications.

How is menometrorrhagia diagnosed?

Your healthcare provider will ask you several questions when working to diagnose abnormal uterine bleeding. These questions may include:

• What brings on the bleeding?
• How long do you bleed?
• How heavy is the bleeding?
• How often do you bleed?
• Do you track your menstrual cycles?
• What other symptoms do you have?
• What medicine, vitamins or supplements do you take?
• Is there a chance that you’re pregnant?

It may help to keep track of your bleeding for several weeks leading up to your appointment. Note when you bleed, how long it lasts, the type (spotting, medium, heavy) and if you have other symptoms with it.

Your healthcare provider will also perform a physical exam, including:

• Pelvic exam
• Pap smear (depending on when your last one was)

What tests will be done to diagnose menometrorrhagia?

The most common steps your provider will do to diagnose the condition are:

• A pregnancy test. Light bleeding is also common in the early stages of pregnancy.
• Blood tests. Your provider can check how your blood clots and do a complete blood count (CBC).
• Hormone levels blood test. Hormone imbalances may be causing your abnormal bleeding, or they may be a sign of a condition causing your bleeding.
• A pelvic ultrasound. Imaging allows your provider to check for any growths in your reproductive organs that may be causing your bleeding. A sonohysterogram, also called saline-infusion sonography, is a highly sensitive imaging procedure that can help your provider identify abnormal structures in your uterus, like polyps or fibroids.

Based on those results, your provider may do the following tests:

• A hysteroscopic exam of your uterine lining. This test checks for fibroids, polyps or signs of cancer.
• A biopsy of your endometrium. Your provider can collect tissue samples from your uterine lining and check for signs of cancer or pre-cancer cells.

What is the treatment for menometrorrhagia?

Your treatment depends on what’s causing your bleeding. Medications and surgical options are available to manage your bleeding or treat what’s causing it.

Medications

Medication is often the first treatment your healthcare provider will consider. Your provider may recommend the following medications for abnormal uterine bleeding:

• Birth control pills
• Progestin (can be given by a shot, implant or IUD)
• Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil®, Motrin®)
• Gonadotropin-releasing hormone (GnRH) agonists and antagonists can temporarily stop or reduce bleeding; they can also shrink the size of fibroids
• Tranexamic acid, to treat heavy menstrual bleeding
• Antibiotics, if the cause of bleeding is an infection
• Iron supplements, if your provider is concerned about anemia

Surgery

There are several procedures available to treat abnormal uterine bleeding. Some options your provider may offer include:

• Hysteroscopy. A procedure where your provider removes atypical structures in your uterus, like fibroids and polyps.
• Uterine artery embolization. A treatment that stops blood flow to fibroids, causing them to shrink.
• Myomectomy. A method of removing fibroids while keeping your uterus intact and preserving your ability to get pregnant in the future.
• Endometrial ablation. A procedure that destroys your uterine lining through the use of a laser, heat, electricity, microwave energy or freezing. You shouldn’t have this procedure if you want to get pregnant in the future.
• Dilation and curettage (D&C). A procedure to remove tissue from your uterus. A D&C can be a diagnostic tool or a treatment for abnormal bleeding. Your provider can send the tissue to a lab for analysis.
• Hysterectomy. A surgery to permanently remove your uterus. It treats cancer or cancerous changes in your endometrium. You lose the ability to get pregnant after a hysterectomy.

Ask your provider about the risks and benefits of surgical procedures. Make sure you know exactly what to expect with each treatment option.

How can I reduce my risk of menometrorrhagia?

You can’t prevent many causes of abnormal uterine bleeding. But you can reduce your risk of certain conditions that lead to abnormal bleeding. For instance, maintaining a healthy weight plays a potential role in keeping your hormones in sync. Practicing safer sex (like wearing a condom) can reduce your risk of certain sexually transmitted infections (STIs) that can cause irregular uterine bleeding.

What can I expect if I have menometrorrhagia?

Getting to the root cause of your irregular bleeding is key to your prognosis. Diagnosing and treating the underlying cause may be a process that takes several weeks, or it could be relatively easy for your provider to diagnose. Either way, your provider will consider multiple factors, including your age, symptoms and risk factors for certain conditions that cause abnormal bleeding.

The good news is that most cases of irregular bleeding are treatable. Follow your provider’s advice and recommendations and be sure to check in with them if a treatment option isn’t working for you. They’re there to help you and get you back to living a life without bothersome or random vaginal bleeding.

When should I see my healthcare provider?

Schedule an appointment with your provider if you notice abnormal uterine bleeding so they can address the underlying cause.

Symptoms to watch out for include:

• Having especially long or especially short menstrual periods that feel random and unpredictable.
• Changing menstrual products every hour for several hours in a row.
• Bleeding in between periods. Even if it’s light spotting.
• Symptoms of anemia, like feeling tired, weak or short of breath.

If abnormal bleeding interferes with your quality of life, see a healthcare provider. You shouldn’t have to double up on menstrual products to manage your period. You shouldn’t have to skip activities you enjoy or avoid going to work and school because of unpredictable bleeding.

What questions should I ask my provider?

Some questions you may want to ask your provider are:

• Is my bleeding abnormal?
• Why do you think I have abnormal uterine bleeding?
• Is my period considered heavy?
• Does my blood loss put me at risk for developing other health conditions?
• Am I bleeding so much that I’m at risk of developing anemia?
• What are the pros and cons of the treatment options available to me?
• What are the best treatment options available if I wish to get pregnant in the future?
• Will you administer my treatment alone, or will it involve a care team?
• What surgical experience do you have in treating abnormal uterine bleeding? Is this a routine part of your practice?