Heavy Menstrual Bleeding | Menorrhagia | Baylor Scott & White Health

Mother and daughter sitting happily on a couch discussing menorrhagia

What is menorrhagia?

Menorrhagia is heavy menstrual bleeding. During a typical menstrual period, women lose approximately three tablespoons of blood over four to five days. However, people with menorrhagia may experience bleeding lasting longer than seven days or heavy bleeding that requires them to change their tampon or pad more than once an hour for several hours in a row.

Heavy menstrual bleeding might be common, with about one-third of women seeking treatment for it, but it isn't normal. It can disrupt your life and may indicate a more serious health condition. If you’re experiencing menorrhagia, talk with your women’s health specialist to find a solution to improve your quality of life.

Menorrhagia symptoms

It can be difficult to identify menorrhagia based on whether you have “heavy” bleeding because every person defines it a little differently.

You may have menorrhagia if you have any of the following symptoms:

Doubling up on pads to keep from leaking
Feeling exhausted or short of breath as a result of blood loss
Heavy menstrual bleeding with clots the size of a quarter or larger
Heavy menstrual flow that disrupts your life
Needing to change sanitary pads or tampons overnight
Periods that last longer than seven days
Soaking through one or more pads or tampons hourly for several consecutive hours

What causes heavy menstrual bleeding?

Sometimes, the cause of heavy periods is unknown. However, several conditions can contribute to this issue, including:

Hormone imbalances

The hormones your body produces, like estrogen and progesterone, regulate your menstrual cycle and the heaviness of your periods. Imbalances in these hormones can cause the endometrial lining to build up excessively, leading to heavy bleeding.

Conditions that disrupt hormone production, such as polycystic ovary syndrome (PCOS), anovulation and thyroid disease, can interfere with ovulation.

Excess body weight can also affect hormone production and contribute to heavy periods. Discuss your ideal body weight with your healthcare provider to see if it may be a factor.

Medications

Birth control pills, implants, injectables, aspirin, blood thinners, and certain antidepressants can cause heavy bleeding. Women with a copper IUD may experience heavy bleeding during the first year of use. Talk with your healthcare provider if you are concerned about potential side effects.

Noncancerous growths

Benign growths in your uterus and conditions that cause abnormal cell growth can also lead to heavy menstrual bleeding. These causes include:

Adenomyosis: In adenomyosis, endometrial tissue grows into the uterine wall. When that happens, pockets of blood may form or blood vessels may become damaged, and you may experience heavy bleeding during your period.
Polyps: Polyps, or benign growths on the cervix or uterus, may cause menorrhagia.
Uterine fibroids: Fibroids, or noncancerous growths in the uterine muscle, may lead to heavy periods.

Infection

Some sexually transmitted infections may cause bleeding from your cervix or vaginal wall, which may be confused with abnormal menstrual bleeding.

Pregnancy complications

Bleeding during early pregnancy may be confused with abnormal menstrual bleeding, especially if you do not know you are pregnant. Tell your doctor about any bleeding if you are pregnant or think you could be pregnant, as it can indicate ectopic pregnancy or miscarriage.

Cancerous growths

Endometrial hyperplasia, a precancerous condition, can lead to menorrhagia. Other cancers affecting the reproductive system, such as uterine, cervical or endometrial cancer, can also cause heavy menstrual bleeding. This is why it’s crucial to speak with your doctor if you notice any changes to your menstrual cycle.

Other medical conditions

Other conditions may also cause heavy or prolonged periods:

Endometriosis
Kidney disease
Pelvic inflammatory disease (PID)
Von Willebrand disease

How is menorrhagia diagnosed?

To diagnose menorrhagia, you may have a physical exam, including a pelvic exam, and lab tests. These may include a pregnancy test and tests for certain sexually transmitted infections (STIs). Depending on your symptoms and age, additional tests may also be required.

Medical history and physical exam

If your provider suspects you have menorrhagia, they’ll talk with you about your personal menstrual history, such as the age you had your first period and how many days your period typically lasts, along with how your periods affect you. They may also ask questions about your birth control method and the medications you are taking.

From there, your provider will perform a thorough physical exam and a pelvic exam or pap smear.
Blood tests

Blood may be drawn to check for iron deficiency anemia. Your provider may also test for other conditions, such as thyroid disease or blood clotting disorders.
Endometrial biopsy

During an endometrial biopsy, your doctor removes a sample of endometrial tissue and examines it under a microscope. Sometimes, hysteroscopy is used to guide this procedure. Another method for this test is a surgical procedure called dilation and curettage (D&C).
Imaging
Imaging tests that can help diagnose menorrhagia include:
- Transvaginal ultrasound: This test uses sound waves to capture detailed images of organs and tissues in the pelvis.
- Hysteroscopy: A hysteroscopy involves inserting a thin scope through the cervix into the uterus to provide a view of the uterus.
- Sonohysterography: This is an imaging exam in which fluid is injected into the uterus through a small tube that passes through the vagina and cervix. Ultrasound technology is then used to capture images of the uterus to help identify issues with the uterine lining.
- Magnetic resonance imaging (MRI): An MRI may be used if an ultrasound doesn’t provide sufficient information about abnormal structures inside your uterus.

Menorrhagia treatment

Excessive menstrual bleeding isn’t something you have to live with. Multiple treatment options can help alleviate bleeding and provide relief from other symptoms.

The treatment your women’s health provider recommends will depend on the causes of your bleeding.

Medications

Initial treatment for heavy menstrual bleeding often involves medications, such as:

Anti-inflammatory medications: Help reduce pain associated with periods
Antifibrinolytics: Slow blood clot breakdown, reducing heavy flows
Contraceptives:Especially IUDs, birth control pills and others, can regulate menstruation and reduce bleeding
Desmopressin nasal spray: Helps stop bleeding for people with inherited bleeding disorders such as mild hemophilia and von Willebrand disease
Drug-releasing intrauterine contraception: Regulates menstruation and reduces bleeding
Hormone therapy : Reduces bleeding for women going through perimenopause
Iron supplements: Treat anemia caused by replacing some iron lost through excessive bleeding

Minimally invasive procedures

Some types of heavy bleeding can be treated more effectively with procedures that can treat the heavy bleeding directly.

Dilation and curettage (D&C): Your provider removes the lining of your uterus with a scraping tool inserted through the cervix.
Hysteroscopy: Your provider removes fibroids that may cause heavy bleeding by using a thin scope inserted into your uterus through your cervix.
Endometrial ablation: Your provider uses electricity, radiofrequency energy, heat or another method to destroy the tissue lining of the uterus to reduce bleeding during periods.
Endometrial resection: Your provider removes the lining of your uterus to prevent menstrual bleeding.
Focused ultrasound: Your provider uses targeted ultrasound to destroy fibroids that may cause heavy bleeding.
Uterine artery embolization (UAE): Your provider blocks the artery that supplies the fibroids with blood.

You should not attempt to get pregnant following endometrial ablation and endometrial resection. Speak with your doctor to find the best option for you.

Surgery

If your heavy bleeding is severe or has a significant impact on your quality of life, you may need surgery. There are two types of surgery for menorrhagia:

A hysterectomy, where your surgeon will remove your entire uterus, and you will no longer have periods or be able to have children.
A myomectomy, where your surgeon will remove fibroids. You will still have periods, so this may be a better option if you want to have children in the future.

Frequently asked questions

Is menorrhagia dangerous?

Menorrhagia is not dangerous, but it can cause anemia, which has its own complications, including feeling very tired, heart problems and pregnancy complications. Also, menorrhagia could indicate other medical conditions so it's important to discuss with your provider.
How can I stop heavy menstrual bleeding with clots?

Your healthcare provider will ask about the size and frequency of your blood clots and determine if there’s an underlying cause. Thyroid disease, polyps, fibroids, bleeding disorders and cancer can all cause heavy bleeding with clots. Based on their evaluation, your provider may recommend a medication or surgery.
How long does menorrhagia last?

Any menstrual bleeding lasting longer than seven days is considered menorrhagia. However, women may bleed for longer if they have certain health conditions, such as coagulation disorders.
Can menorrhagia cause infertility?

Yes, infertility is occasionally a complication of abnormal uterine bleeding. Some treatments for menorrhagia, such as hysterectomy, may also result in infertility.
Can birth control help menorrhagia?

Yes, some women find that hormonal birth control can make periods lighter or more regular.
Can heavy menstrual bleeding cause anemia?

Yes, heavy menstrual bleeding can cause anemia. This is one reason it is important to tell your doctor about heavy or long periods.
Can I go to urgent care for heavy menstrual bleeding?

Seek emergency care if you experience acute abnormal uterine bleeding: You need to change your tampon or pad every hour for more than two hours, and you feel dizzy, lightheaded or have pain in your chest.

Understanding the cause of heavy menstrual bleeding may take time and several diagnostic tests. Your best guide through this process is a regular healthcare provider, such as an OBGYN.

Menorrhagia (Heavy Menstrual Bleeding)

What is menorrhagia?

Menorrhagia symptoms