model of female reproductive system

Menstruation is a big part of a woman’s life. Having a period is the body’s natural way of releasing tissues it no longer needs, which come out in the form of blood every month (via Healthline). However, when your period is unusually long, this is known as menorrhagia, per WebMD. With this condition, you may lose twice as much blood during your period if the duration exceeds 7 days, which might trigger subtle health problems, according to WebMD. In normal situations, menstrual bleeding usually lasts about 4 to 5 days, and the amount of blood lost is about 2 to 3 tablespoons, according to Healthline.

A 2012 study published in the journal Clinical Medical Insights: Women’s Health deems menorrhagia to be a public health challenge that affects over 18 million women worldwide. This condition can limit normal activity and cause anemia in about two-thirds of women, according to another 2012 study published in the journal BMJ Clinical Evidence. Despite the condition’s critical nature, many women who experience heavy menstrual bleeding know little about it. Here are the causes, symptoms, and available treatment options for menorrhagia.

Causes of menorrhagia

doctors assessing reproductive organs

The causes of menorrhagia vary, but hormonal imbalance is one of the most common, according to Healthline. If you develop too much estrogen, the uterine line thickens and sheds, eventually leading to blood loss and clots, per Healthline. Several uterine-related problems can also cause menorrhagia. They include uterine fibroids, cancer of the cervix or uterus, miscarriages, and ectopic pregnancies, per the Centers for Disease Control and Prevention (CDC).

Another cause of menorrhagia is adenomyosis, according to Medscape. This is a gynecologic condition that causes the endometrial tissue to outgrow into the uterus walls, enlarging the uterus (via Johns Hopkins Medicine). This condition can cause severe bleeding, especially in women who have had previous surgeries, or during the late childbearing age range of 35 to 50.

Menorrhagia is also common among women with inherited bleeding disorders, per the Haemophilia Society. For example, women with hemophilia might experience a reduced blood clot ability, which can cause intense bleeding. Von Willebrand’s Disease is another inherited bleeding disorder associated with heavy menstrual bleeding.

Menorrhagia can also be a side effect of certain medications. For instance, you may be at a high risk of prolonged heavy menstrual bleeding if you use anti-inflammatory drugs, hormonal medications, or anticoagulants. (via Mayo Clinic).

Symptoms of menorrhagia

woman holding stomach

As noted previously, periods usually last about 4 to 5 days. However, heavy periods are common and may be normal unless the flow interferes with your quality of life, notes the National Health Service (NHS). Heavy flow that exceeds 7 days, causes you to take time off work, or avoid normal daily activities might indicate menorrhagia, per the NHS. Also, if you experience blood loss to the point where you’re forced to change pads every hour to prevent overspills, this is a tell-tale symptom of menorrhagia, per WebMD.

Menorrhagia is also characterized by the frequent passage of blood clots larger than a quarter, per MedicalNewsToday. Small clots in your menstrual flow are normal and common, and you might occasionally spot some bigger-sized clots. However, frequent, large-sized clots can be indicative of a problem, according to Healthline.

It’s important to communicate these symptoms to your doctor to prevent complications. Untreated heavy bleeding can cause anemia, which is associated with symptoms of fatigue and chest pain, as stated by MedicalNewsToday.

How is menorrhagia diagnosed?

doctor assessing patient with menorrhagia

According to Johns Hopkins Medicine, menorrhagia diagnosis usually begins with a thorough assessment of your medical history and menstruation cycles. Your doctor might physically examine your pelvis and ask various questions, including the number of pads or tampons you use during periods. An obstetrician or gynecologist may collaborate with a hematologist to perform several tests in diagnosing menorrhagia, per the American College of Obstetricians and Gynecologists (ACOG). These professionals can diagnose the condition by testing you for anemia or the presence of bleeding and endocrine disorders.

Your doctor may propose further medical tests to diagnose menorrhagia due to its numerous causes. For instance, a thyroid test can reveal ovary malfunctions causing heavy menstrual bleeding, per the Cleveland Clinic. Hormone levels tests can also help if your doctor suspects your heavy bleeding stems from hormone imbalances. Furthermore, an endometrium biopsy can check for cancerous cells after assessing tissue samples from your uterus, per the Cleveland Clinic. If your heavy menstrual bleeding relates to underlying conditions like fibroids or polyps, your doctor might recommend a hysteroscopic exam for an effective diagnosis.

Treatment options for menorrhagia

woman taking medications

Fortunately, various treatment options exist to help people with menorrhagia manage the various symptoms. According to the American Academy of Family Physicians (AAFP), oral progestogens are commonly prescribed for menorrhagia. The dosage and time taken will depend on your doctor’s prescriptions. As a general guide, the medication is usually taken for 21 continuous days to effectively reduce menstrual blood loss, per the AAFP.

Surgical hysterectomy treatment is also effective, but it comes at a high cost and can be linked to several surgical morbidities. Given its costs and high risk, many women opt for minimally invasive methods of endometrial destruction to prevent side effects. The Centers for Disease Control and Prevention (CDC) lists desmopressin and tranexamic acid as two non-invasive therapies that can be effective alternatives to hysterectomy. Both options have been noted to significantly reduce menstrual blood loss and improve the quality of life for women with menorrhagia, per the CDC.

When you should see a doctor

doctor and patient with menorrhagia

The importance of talking to your doctor regarding heavy menstrual bleeding can’t be overemphasized, especially if you experience menorrhagia-related symptoms. Healthline advises treating menorrhagia as an emergency when the condition is associated with symptoms of anemia, such as severe weakness, tiredness, or lightheadedness (which are all due to the body losing too many blood cells). A 2011 study in the American Journal of Obstetricians and Gynecologists reveals a significant relationship between menorrhagia and severe life-threatening anemia. Although menorrhagia itself isn’t life-threatening, leaving the condition untreated can cause you to lose more blood than necessary, which can develop into critical anemia, per the study’s findings.

According to another 2013 study published in the journal ISRN Obstetrics and Gynecology, menorrhagia can also significantly affect personal, social, family, and work life. The condition can become an emergency if it leads to hypovolemia, a rare condition associated with fatigue and dizziness, per the Cleveland Clinic. According to the source, hypovolemic shock affects 1 in 1,000 people and is often characterized by a large loss of blood, exceeding 20% of the total blood volume. To establish a connection between menorrhagia and hypovolemia, your doctor will assess your menstrual period frequency to understand how often episodes of heavy vaginal bleeding occur.