Disease, Condition & InjuryPelvis conditionsReproductive organs conditions

Heavy menstrual bleeding

(Menorrhagia; Hypermenorrhea)

Heavy menstrual bleeding – Definition

Heavy menstrual bleeding (also called menorrhagia) is excessive menstrual blood loss that interferes with a woman’s quality of life.

Heavy menstrual bleeding – Causes

In some cases, the cause is not known. However, many conditions have been associated with menorrhagia, such as:

  • Uterine fibroid
  • Bleeding disorder (eg, von Willebrand disease)
  • Hormonal imbalance
  • Cervical or endometrial polyp
  • Ovarian cyst
  • Certain medicines
  • Intrauterine device (IUD)

Heavy menstrual bleeding – Risk Factors

Factors that may increase the risk of menorrhagia include:

  • Being an adolescent
  • Approaching menopause

Heavy menstrual bleeding – Symptoms

Symptoms of menorrhagia include:

  • Menstrual bleeding lasting more than seven days
  • Unusually heavy bleeding (soaking through a sanitary napkin or tampon every hour)
  • Menstrual flow requiring change of sanitary protection during the night
  • Menstrual flow including large clots
  • Menstrual flow interfering with lifestyle
  • Fatigue and/or shortness of breath (symptoms of anemia)

When Should I Call My Doctor?

Call your doctor if you have symptoms of menorrhagia.

Heavy menstrual bleeding – Diagnosis

Your doctor will ask about your symptoms and medical history. A physical examination, including a pelvic exam, will be done. Tests may include:

  • Pap test
  • Blood tests
  • Transvaginal ultrasound
  • Endometrial biopsy (removal of a sample of endometrial tissue)
  • Dilation and curettage (scraping of the inner lining of the uterus)
  • Hysteroscopy (examination of the cervix and fallopian tubes)

Heavy menstrual bleeding – Treatment

Treatment depends on the underlying cause of the heavy menstrual bleeding. Your doctor will work with you to create a treatment plan.


Your doctor may recommend:

  • Hormonal therapy
  • An IUD that releases the hormone progesterone
  • Nonsteroidal anti-inflammatory drugs
  • Iron supplement

Surgical Procedures

In some cases, surgery may be needed, such as:

  • Dilation and curettage
  • Operative hysteroscopy (may be used along with other tools to remove a polyp)
  • Endometrial ablation (removal of the lining of the uterus) — This procedure reduces your chance of becoming pregnant.
  • Hysterectomy (removal of the uterus) — After this procedure, you will not be able to become pregnant.

Heavy menstrual bleeding – Prevention

There are no specific steps to prevent this condition.

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