Description

Some women have menstrual bleeding that is heavy or lasts for more than a few days. This condition used to be called menorrhagia. Menstrual bleeding is a common concern. But most women do not have enough, the loss of blood, which is called menstrual bleeding.

Some women have menstrual bleeding between periods or before or after in their cycles of waiting. This type of bleeding is called abnormal uterine bleeding or irregular menstrual bleeding.

With menstrual bleeding, the blood flow and cramps make it harder to do their usual activities. If you dread your period because you have excessive menstrual bleeding, talk with your doctor. There are many treatments that can help.

Symptoms

Symptoms of menstrual bleeding may include:

  • Soaking through one or more sanitary pads or tampons every hour for several hours in a row.
  • The need of the double sanitary protection to control your menstrual flow.
  • You get up at night to change sanitary napkins or tampons.
  • Bleeding for more than a week.
  • Passing blood clots larger than a quarter.
  • The limitation of daily activities due to heavy menstrual flow.
  • Feeling tired, fatigued or short of breath as a result of the loss of blood.

When to see a doctor

Seek medical help before your next test if you have:

  • Vaginal bleeding is so heavy that soaks at least one pad or tampon an hour for more than two hours in a row.
  • Bleeding between periods or unusual vaginal bleeding.
  • Vaginal bleeding after menopause.

Causes

In some cases, the reason for the heavy menstrual bleeding is unknown. But a number of conditions that can cause heavy menstrual bleeding. They include:

  • The hormones are out of balance.In a typical menstrual cycle, there is a balance between the hormones estrogen and progesterone. This controls the formation of the lining of the uterus. The lining of the uterus is also known as the endometrium. This lining is shed during the menstrual period. When hormones are out of balance, the coating becomes too thick and sheds by way of heavy menstrual bleeding or unexpected bleeding between periods. A number of conditions that can cause hormonal imbalances. These include obesity, insulin resistance, thyroid disorders and polycystic ovary syndrome, also called polycystic ovary syndrome.
  • Problems with the ovaries. Sometimes the ovaries do not release an egg during the menstrual cycle. This is also known as anovulation. When this happens, the body does not produce the hormone progesterone, the way in which it typically does during a menstrual cycle. This leads to a hormonal imbalance and can result in heavy menstrual bleeding or unexpected bleeding between periods.
  • Uterine fibroids. These tumors develop during childbearing years. They are benign, which means non-cancerous. Uterine fibroids can cause heavier than normal menstrual bleeding, or bleeding that occurs over a long time.
  • The polyps. These small growths in the lining of the uterus can cause heavy menstrual bleeding or lasts a long time. They can cause bleeding between periods. Polyps can also cause spotting or bleeding after menopause. The tumors are not cancerous.
  • Adenomyosis. In this condition, the glands of the mucous membrane of the uterus grow in the wall of the uterus itself. This can cause heavy bleeding and painful periods.
  • Intrauterine device, also called an IUD. Menstrual bleeding is a well-known side effect of the use of a hormone-free iud for birth control. Talk with your doctor about other birth control options. IUD with progestogen can relieve your heavy menstrual bleeding.
  • Complications in pregnancy. A single heavy, delay may be due to a miscarriage. Another cause for bleeding during pregnancy includes the unusual location of the placenta, which supplies nutrition to the baby and removes waste. The placenta may be too low or that covers the opening of the uterus which is called the cervix. This condition is also known as placenta previa.
  • Cancer. Cancer of the uterus or cervix can cause abnormal uterine bleeding, or unexpected menstrual bleeding. These types of cancer can happen before or after the menopause. Women who have had an abnormal Pap test in the past, are at increased risk of cancer of the cervix.
  • Genetic bleeding disorders. Some bleeding disorders that run in families cause heavy menstrual bleeding. These include von Willebrand disease, a condition in which the blood does not clot properly.
  • Drugs. Some medicines may be heavy or long menstrual bleeding. These include hormonal drugs, such as birth control pills that have estrogen and progestin. These medications often help decrease menstrual bleeding, but sometimes cause bleeding between periods. Medicines that prevent blood clots can also cause heavy menstrual bleeding. They include warfarin (Jantoven), enoxaparin (Lovenox), apixaban (Eliquis) and rivaroxaban (Xarelto).
  • Other medical conditions. A number of other medical conditions that can cause heavy menstrual bleeding. They include the liver, kidney, and thyroid disease.

The hormones are out of balance. In a typical menstrual cycle, there is a balance between the hormones estrogen and progesterone. This controls the formation of the lining of the uterus. The lining of the uterus is also known as the endometrium. This lining is shed during the menstrual period. When hormones are out of balance, the coating becomes too thick and sheds by way of heavy menstrual bleeding or unexpected bleeding between periods.

A number of conditions that can cause hormonal imbalances. These include obesity, insulin resistance, thyroid disorders and polycystic ovary syndrome, also called polycystic ovary syndrome.

Risk factors

The risk factors vary with age and medical conditions that you have. Generally, the release of an egg from the ovaries to the signals your body to make progesterone. Progesterone is the hormone most responsible for maintaining the regular periods. If the egg is not released, the body does not produce enough progesterone. This can result in heavy menstrual bleeding or unexpected bleeding between periods.

In adolescents, a period irregular or excessive menstrual bleeding often occurs when the egg is not released during a monthly cycle. Adolescents are more likely to have cycles without a release of the egg during the first year after your first period.

In the elderly women of reproductive age, menstrual bleeding is often caused by problems with the uterus. These include fibroids, polyps, and adenomyosis. But other problems can also cause heavy menstrual bleeding. Examples include cancer of the uterus, bleeding disorders, side effects of medications, and disease of the liver or kidney.

Complications

Menstrual bleeding that is too heavy or lasts for too long it can lead to other medical conditions. These include:

  • Anemia.Menstrual bleeding can cause anemia related to blood loss. The Anemia is a condition in which the body lacks sufficient red blood cells to carry oxygen to the tissues. The number of red blood cells is measured by hemoglobin. Hemoglobin is a protein in red blood cells that carries oxygen to tissues throughout the body. Iron deficiency Anemia occurs when the body tries to compensate for the loss of red blood cells. The body uses the reserves of iron to make more hemoglobin, so that the sufficient amount of oxygen can be carried to the tissues. Menstrual bleeding can cause iron levels too low. This may result in iron-deficiency anemia. Symptoms include headaches and feeling tired. Despite the fact that diet plays a role in iron deficiency anemia, the problem is exacerbated by the menstrual periods.
  • The severe pain. Along with the menstrual bleeding, you may have painful menstrual cramps. This is also known as dysmenorrhea. Talk with your doctor if your cramps make it difficult to perform their daily activities.

Anemia. Menstrual bleeding can cause anemia related to blood loss. The Anemia is a condition in which the body lacks sufficient red blood cells to carry oxygen to the tissues. The number of red blood cells is measured by hemoglobin. Hemoglobin is a protein in red blood cells that carries oxygen to tissues throughout the body.

Iron deficiency Anemia occurs when the body tries to compensate for the loss of red blood cells. The body uses the reserves of iron to make more hemoglobin, so that the sufficient amount of oxygen can be carried to the tissues. Menstrual bleeding can cause iron levels too low. This may result in iron-deficiency anemia.

Symptoms include headaches and feeling tired. Despite the fact that diet plays a role in iron deficiency anemia, the problem is exacerbated by the menstrual periods.

Diagnosis

A member of your health care team will probably ask about your medical history and menstrual cycles. You can ask to keep a journal to track days with and without bleeding. Record information such as how heavy your flow was and how many of the sanitary pads or tampons necessary to control it.

After doing a physical exam, your doctor or another member of your health care team may recommend certain tests or procedures. They may include:

  • Blood tests. A sample of your blood can be tested for iron deficiency anemia. The sample can also be tested for other conditions, such as thyroid disorders or blood-clotting problems.
  • The pap test. In this test, cells from your cervix are collected. They are tested for inflammation or changes that may be precancerous, meaning that it can lead to cancer. The cells are also tested for human papilloma virus in women between the ages of 25 to 30 years of age.
  • The biopsy of the endometrium. Your doctor may take a sample of tissue from inside the uterus. A pathologist will examine you for signs of cancer or pre-cancer of the uterus.
  • Ultrasound. This imaging method that uses sound waves to create images of your uterus, the ovaries, and the pelvis.

The results of these initial tests can lead to more tests, including:

  • Sonohysterography. During this test, a fluid is injected through a tube into the uterus through your vagina and cervix. Your doctor then uses ultrasound to detect problems in the lining of the uterus.
  • The hysteroscopy. A thin, lighted instrument is inserted through the vagina and cervix into the uterus. This allows the doctor to view the inside of your uterus.

Your doctor can make a diagnosis of menstrual bleeding or abnormal uterine bleeding only after it knows that something is not the cause of your condition. These causes may include menstrual disorders, medical conditions or medications.

Treatment

The treatment for heavy menstrual bleeding is based on a number of factors. These include:

  • Your general state of health and your medical history.
  • The cause of the condition and how serious it is.
  • How to tolerate certain medications or procedures.
  • The possibility that their periods will soon be less heavy.
  • Your plans to have children.
  • How the disease affects their life style.
  • Your opinion or personal choices.

Medications

Medications for menstrual bleeding may include:

  • Nonsteroidal anti-inflammatory drugs, also called Nsaids. Nsaids , such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), helps to reduce menstrual blood loss. Nsaids also can make menstrual cramps less painful.
  • Tranexamic acid. Tranexamic acid (Lysteda) helps to reduce menstrual blood loss. This drug should only be taken at the time of the bleeding.
  • The oral contraceptives. Aside from birth control, oral contraceptives can help regulate the menstrual cycle, ease menstrual bleeding that is heavy or lasts for a long time.
  • Oral progesterone. The natural hormone progesterone can help correct the hormonal imbalance and reduce menstrual bleeding. The synthetic form of progesterone is called progestin.
  • HormonalIUD(Mirena, Liletta, other). This intrauterine device releases a type of progestin called levonorgestrel. This causes the uterine lining thin and reduces the flow of blood and menstrual cramps.
  • Other medications. The gonadotropin-releasing hormone agonists and antagonists are also called GnRH medications. Help control a uterine hemorrhage. Relugolix combination with an estrogen and a progestin (Myfembree) can help to control bleeding caused by fibroids. Elagolix with an estrogen and a progestin (Oriahnn) is used for the treatment of fibroid bleeding. Elagolix alone (Orilissa) can help control the bleeding caused by the endometriosis.

If you have excessive menstrual bleeding of taking the hormone of the medicine, it may be necessary to stop or change the medication.

If you have anemia due to heavy menstrual bleeding, you may need to take iron supplements. If your iron levels are low, but still you're not anemic, you can start taking iron supplements instead of waiting until they become anemic.

Procedures

You may need surgery for heavy menstrual bleeding if medications don't help. The treatment options include:

  • Dilation and curettage, also called a D&C. In this procedure, the doctor opens the cervix. This is also called the dilation of the cervix. Then, the doctor scraped or suctioned tissue from the lining of the uterus. This is also known as curettage. You can have a D&C to find the source of abnormal uterine bleeding. Causes of bleeding may include polyps, fibroids, or cancer of the uterus. If you have had a miscarriage, you may need a D&C to empty the uterus. Hysteroscopy is often used with D&C to help doctors to identify the source of bleeding in the uterus.
  • Embolization of the uterine artery. The goal of this procedure is to block the flow of blood to the fibroids. Blocking the flow of blood to the fibroids helps to reduce the size of them. During the procedure, the surgeon inserts a catheter through the large artery in the thigh. This is also known as the femoral artery. The surgeon guides the catheter to the blood vessels in the uterus and inject small beads or sponges in order to reduce the flow of blood to the fibroid.
  • Focused ultrasound. This procedure shrinks fibroids by the orientation and the destruction of fibroids through waves of ultrasound and radio frequency. No incisions are required.
  • Myomectomy. This is the surgical removal of uterine fibroids. Depending on the size, number and location of the fibroids, the surgeon may perform a myomectomy through several small incisions in the abdomen. This is also known as the laparoscopic approach. Or the surgeon may place a thin flexible tube into the vagina and the cervix to see and remove the fibroids or polyps in the uterus. This is also called the hysteroscopic approach.
  • Endometrial ablation.This procedure involves destroying the lining of the uterus. The process of tissue destruction is also known as ablation. The surgeon uses a laser, radio waves, or heat applied to the lining of the uterus to destroy the tissue. After endometrial ablation, you may have much lighter periods. Pregnancy after endometrial ablation is not likely, but it is possible and may be dangerous. Using reliable or permanent form of birth control until menopause, it is recommended.
  • Endometrial Resection. The surgeon uses an electrosurgical wire loop to remove the lining of the uterus. Pregnancy is not recommended after this procedure.
  • The hysterectomy. In this procedure, the uterus and the cervix are removed. Ends menstrual periods, and the ability to get pregnant. The hysterectomy is done under anesthesia and may require a short stay in the hospital. Early menopause can occur if the ovaries are removed. The procedure to remove both ovaries is called an oophorectomy.

Endometrial ablation. This procedure involves destroying the lining of the uterus. The process of tissue destruction is also known as ablation. The surgeon uses a laser, radio waves, or heat applied to the lining of the uterus to destroy the tissue.

After endometrial ablation, you may have much lighter periods. Pregnancy after endometrial ablation is not likely, but it is possible and may be dangerous. Using reliable or permanent form of birth control until menopause, it is recommended.

Many of these surgical procedures are performed on an outpatient basis. You may need general anesthesia, but more likely it is that you can go home the same day. With a myomectomy or abdominal hysterectomy, you may need a short stay in the hospital.

Sometimes the menstrual bleeding is a sign of another condition, such as thyroid disease. In such cases, the treatment of the disease usually results in lighter periods.

Preparing for your appointment

You can start by seeing your primary care physician or other health care professional. Or you may be referred immediately to a specialist called an ob/gyn.

Here's some information to help you prepare for your appointment.

What you can do

When you make the appointment, ask if there is something that you need to do in advance, such as fasting before a specific test. Make a list of:

  • Your symptoms, including any that seem unrelated to the reason for your appointment.
  • Key personal information, including major stresses, recent life changes and family medical history.
  • All medications, vitamins or supplements that you are taking, including the dosage.
  • Questions to ask your doctor.

Have a friend or family member, if possible, to help you remember the information they give you.

For heavy menstrual bleeding, some basic questions to ask your care team include:

  • What is likely causing my symptoms?
  • Other that the most likely cause, what are other possible causes of the symptoms?
  • What tests do I need?
  • Is my condition likely temporary or will it be permanent?
  • What are my treatment options?
  • I have these other health conditions. How can I best manage them together?
  • You should see a specialist?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask any other questions as they occur during your appointment.

What to expect from your doctor

You can't ask certain questions during your appointment, such as:

  • When did your symptoms begin?
  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

What you can do in the meantime

Avoid doing anything that seems to make your symptoms worse.

Symptoms and treatment of heavy menstrual bleeding