Menorrhagia (Heavy Menstrual Bleeding)

Overview

What is menorrhagia?

Menorrhagia is a common disorder in women. Menorrhagia is the medical term for menstrual bleeding lasting for longer than 7 days. About 1 in every 20 women has menorrhagia.

Some of the bleeding can be very heavy, meaning you would change your tampon or pad after less than 2 hours. It can also mean you pass clots the size of a quarter or even larger.

Menorrhagia can lead to anemia if not treated. Also, the heavy bleeding can affect sleep, cause lower abdominal pain and make enjoyable activities a burden.

If you are experiencing weakness and a disruption to everyday life due to heavy bleeding, you should ask your doctor for treatment options.

Symptoms and Causes

What are the signs and symptoms of menorrhagia?

Signs of menorrhagia include:

  • Soaking 1 or more tampons or pads every hour for many consecutive hours
  • Doubling up on pads
  • Changing pads or tampons during the night
  • Long-lasting menstrual periods (longer than 7 days)
  • Blood clots the size of a quarter or larger
  • Bleeding that is keeping you from doing normal activities
  • Constant pain in lower part of stomach
  • Lacking energy
  • Shortness of breath

What causes menorrhagia?

Menorrhagia can be caused by uterine problems, hormone problems or other illnesses. Other causes include:

  • Growths or tumors of the uterus that are not cancer
  • Cancer of the cervix or uterus
  • Particular types of birth control
  • Pregnancy-related problems (miscarriage or ectopic pregnancy, when the fertilized egg implants outside the uterus)
  • Bleeding disorders
  • Liver, kidney or thyroid disease
  • Pelvic inflammatory disease (and infection of the female reproductive organs)
  • Taking certain drugs, such as aspirin
  • The menopause transition, also referred to as perimenopause
  • Childbirth
  • Fibroids or polyps in the lining or muscle of the womb

Diagnosis and Tests

How is menorrhagia diagnosed?

Menorrhagia is diagnosed by your doctor through a series of questions about your medical history and menstrual cycles. Usually for women with menorrhagia bleeding lasts for more than 7 days and more blood is lost (80 milliliters compared to 60 milliliters).

Your doctor may ask for information about:

  • Your age when you got your first period
  • Length of your menstrual cycle
  • Number of days your period lasts
  • Number of days your period is heavy
  • Quality of life during your period
  • Family members with a history of heavy menstrual bleeding
  • Stress you are facing
  • Weight problems
  • Current medications

Physical tests or exams done to diagnose menorrhagia may include:

  • Pelvic exam
  • Blood test to check thyroid, check for anemia and how the blood clots
  • Pap test to check cells from cervix for changes
  • Endometrial biopsy to check uterine tissue for cancer or abnormalities
  • Ultrasound to check function of blood vessels, tissues and organs

Sometimes additional tests are still required to understand the cause of bleeding, including:

  • Sonohysterogram to check for problems in the lining of the uterus
  • Hysteroscopy to check for polyps, fibroids or other problems
  • Dilation and curettage (“D&C”). This test can also treat the cause of the bleeding. During this test, the lining of the uterus is scraped and examined under sedation.

Management and Treatment

How is menorrhagia treated?

Treatment for menorrhagia depends on how serious the bleeding is, the cause of the bleeding, your health, age, and medical history. Also, treatment depends on your response to certain medicines and your wants and needs. You may not want to have a period at all, or just want to reduce the amount of bleeding. In addition, your decision to get pregnant or not will affect what treatment you choose. If you do not have anemia, you can choose to not have treatment.

Common treatments include:

  • Iron supplements to put more iron into your blood
  • Ibuprofen to reduce pain and amount of bleeding
  • Birth control to make periods more regular and reduce bleeding (pills, vaginal ring, patch)
  • Intrauterine contraception (IUD) to make periods more regular and reduce bleeding
  • Hormone therapy to reduce bleeding
  • Desmopressin nasal spray to stop bleeding for certain bleeding disorders
  • Antifibrinolytic medicines to reduce bleeding
  • Dilation and curettage to reduce bleeding by removing the top layer of uterus lining
  • Operative hysteroscopy to remove fibroids and polyps and remove lining of uterus
  • Endometrial ablation or resection to remove all or part of the lining of the uterus
  • Hysterectomy to surgically remove the uterus and you will stop having your period

How is menorrhagia managed?

To manage menorrhagia, some women stay home on days when they are bleeding heavily. Others leave the house if they know a bathroom will be nearby. Also, it is a good practice to keep pads and/or tampons in your purse or at work. Wearing dark pants or skirts can help if you are worried about stains on light-colored clothing. Additionally, you can use a waterproof sheet on your mattress to prevent stains.

Prevention

How is menorrhagia prevented?

Menorrhagia cannot be prevented. However, talking with your doctor to get diagnosed and treated can prevent other health issues in the future.

Outlook / Prognosis

What is the prognosis for living with menorrhagia?

If left untreated, menorrhagia can interfere with daily life. In addition, it can cause anemia and leave you feeling tired and weak. Other health problems can also arise if the bleeding problem is not resolved. With proper treatment and doctor assistance, menorrhagia can be managed and not cause a disruption to your life.

Living With

When do you call the doctor if you suspect menorrhagia?

You should call the doctor if you are passing clots the size of a quarter or larger. You should also call the doctor if you need to change your tampon or pad after less than 2 hours due to heavy bleeding.

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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy