Heavy menstrual bleeding (menorrhagia) Causes, symptoms


Menorrhagia (heavy menstrual bleeding) can cause serious medical problems and complications. If you have heavy periods, you should make an appointment with your gynecologist . Sometimes severe bleeding is a medical emergency.

Get Medication Information / Brianna Gilmartin


The easiest way to tell if you are experiencing heavy menstrual bleeding is to write down how often you rub a sanitary pad or tampon.

If your period is heavy enough to require you to change your tampon or tampon every hour for several hours, or if you have vaginal bleeding that lasts for more than a full week, you have heavy menstrual bleeding.

Other signs of heavy menstrual bleeding include:

  • Using more than one sanitary pad at a time to stop bleeding.
  • Having to change your tampon or pillow in the middle of the night.
  • If your menstrual blood has clots of a quarter or larger

When menstrual bleeding is urgent

Go to the nearest emergency room if you experience severe, sharp bleeding that causes you to soak four or more pads or tampons for two hours. If you are pregnant, seek immediate medical attention if you have menstrual bleeding.


There are several different causes of heavy menstrual bleeding, including benign (benign) growths, such as fibroids, or malignancies, such as uterine or cervical cancer. Hormonal changes or bleeding disorders can also cause menorrhagia.

Other less common causes of heavy menstrual bleeding include endometriosis and the presence of an intrauterine device (IUD) like ParaGard , which can cause excessive bleeding, especially during the first year of use.

But the list does not end there. This emphasizes the importance of visiting your healthcare provider for a correct diagnosis and evaluation.

Ovulatory dysfunction

The most common cause of heavy menstrual bleeding is ovulatory dysfunction during adolescence or perimenopause . During this time, ovulation (release of an egg) can be irregular, meaning it may not occur every month. This can lead to thickening of the endometrium (lining of the uterus) and heavy periods.

Oral contraceptives can generally regulate bleeding during adolescence, and hormone therapy can help during menopause.

In addition to the normal hormonal changes that occur during puberty or menopause, hormone-induced ovulatory dysfunction can also occur with hypothyroidism , polycystic ovarian syndrome (PCOS) , and premature ovarian failure. Treating your underlying problem is important and can help restore regular ovulation and normalize your menstrual cycle.

Myoma of the uterus

A fibroid is a mass that develops from the muscles of the uterus, usually between the ages of 30 and 49.

Uterine fibroids are dependent on estrogens. Hormonal contraceptives, such as birth control pills, can help reduce heavy menstrual bleeding from fibroids.

If your symptoms are not severe or bothersome, you may not need fibroid treatment; often "wait and see" is enough. During menopause, fibroids generally shrink and go away without treatment.

Progestin-releasing intrauterine devices (IUDs) can reduce menstrual bleeding, but they do not shrink fibroids. Injectable gonadotropin-releasing hormone agonists can shrink, but can only be used for a short time due to their side effects.

Endometrial ablation (the lining of the uterus breaks down) is a procedure that can be used to treat small fibroids. Surgical options include myomectomy (removal of the fibroid) and uterine artery embolization (cutting off the blood supply to the fibroid) .

In the most severe cases, a hysterectomy may be necessary, which removes the entire uterus with or without ovaries.

Polyps of the uterus

Endometrial polyps are usually benign grape-shaped growths that protrude from the lining of the uterus. They can develop before and after menopause. The cause of endometrial polyps is unclear, although studies show a link between hormone therapy and obesity.

It is not necessary to treat small polyps unless you are at risk for uterine cancer. In this case, your doctor may recommend a polypectomy , in which the polyp is removed for microscopic examination. As a precaution, large polyps are usually removed and examined.

Adenomyosis of the uterus

Adenomyosis of the uterus is a condition in which the cells of the uterus from the endometrium grow into the muscular wall of the uterus, causing an enlargement of the uterus and profuse and painful bleeding. Hormonal birth control methods can help control the condition, and the definitive treatment for adenomyosis is hysterectomy .

Pelvic inflammatory disease (PID)

PID is most commonly caused by untreated sexually transmitted infections (STIs), but it can sometimes occur after childbirth, an abortion, or other gynecological procedures. With PID, one or more reproductive organs can become infected, including the uterus, fallopian tubes, and / or cervix. The recommended treatment for PID is antibiotic therapy .

Cervical or endometrial cancer.

Cervical cancer , which can be caused by the human papillomavirus (HPV) (asymptomatic STI), can affect other parts of the body. Treatment for cervical cancer includes surgery, chemotherapy, and / or radiation therapy .

Endometrial cancer occurs when abnormal endometrial cells invade the uterus and / or other organs. Although the cause of endometrial cancer is unknown , the most common age for diagnosis is the mid-60s.

Treatment for endometrial cancer is usually a hysterectomy, which may be followed by chemotherapy and / or radiation therapy .

Early diagnosis is the key to effective cancer treatment. In addition to regular Pap tests for cervical cancer, the American Cancer Society recommends that women at high risk for endometrial cancer have an endometrial biopsy annually .

Bleeding disorders

Although there are several types of bleeding disorders, the most common type in women is von Willebrand disease (VWD). Treatment for von Willebrand disease involves releasing accumulated clotting factors into the blood or, in extreme cases, replacing clotting factor when given intravenously or with a prescription nasal spray.

Other bleeding problems that can lead to heavy menstrual bleeding include a low platelet count ( platelets are involved in clotting and are made in the bone marrow) or taking blood thinners such as aspirin or coumadin (warfarin sodium) .


It is important to get a diagnosis that explains the cause of heavy menstrual bleeding. Before your visit, try to write down a menstrual chart from the last few months.

For example, how many days did you bleed out each month? How many sanitary pads or tampons do you use during your heaviest periods?

Make sure you have a list of all your medications, including hormonal contraceptives, hormone therapy, and any over-the-counter vitamins or supplements.

Diagnostic tests such as:

  • Pregnancy test (if premenopausal)
  • Blood tests (such as complete blood count, iron levels, and thyroid hormones)
  • Pelvic ultrasound

Your healthcare provider may also perform a hysteroscopy , which is a diagnostic procedure used to view the inside of your uterus. They may also perform an endometrial biopsy to take a sample of uterine tissue for microscopic examination.

Get the word of drug information

Coping with heavy menstrual bleeding is important to your quality of life and your overall health. Severe blood loss, whatever the cause, can cause iron deficiency anemia , which can cause shortness of breath, fatigue, and dizziness .

Once the bleeding and the underlying cause of the bleeding are addressed and treated, you can go ahead and feel good – you deserve it.

Frequently asked questions

  • If the bleeding is hormonal, prostaglandin inhibitors (non-inflammatory drugs), birth control pills, and progesterone can help. For endometrial problems, treatment options include ablation , resection (removal) of the lining of the uterus, or hysterectomy. In May 2020, the FDA approved Orianne (Elagolix, Estradiol and Norethindrone Acetate Capsules; Elagolix Capsules) for severe bleeding due to fibroids.

  • There are no FDA-approved natural remedies for heavy periods, but some have been studied. Among the promising ones:

    • Ginger capsules
    • Myrtle syrup
    • Punica granatum ( pomegranate ) flower capsules
    • Banana syrup

    Check with your doctor before taking any supplements.

  • Maybe. In the studies, women who had anemia due to menorrhagia experienced a number of positive benefits from iron supplements : more energy and physical activity, healthier social lives, and less anxiety and depression. Check with your doctor to see if you have anemia and if you think iron supplements can help.

  • Depending on the cause, the amount of blood lost, and any complications such as:

    • Intravenous (IV) fluids to replace lost fluids
    • Blood transfusion
    • Intravenous estrogen
    • Inserting a balloon catheter into the uterus, which expands to pressurize the bleeding blood vessels.
    • Treatment of hemorrhagic shock if it occurs

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