What is Menorrhagia?

For many women, it is normal to have an irregular cycle where a period may last longer than another or you may bleed more. However, menorrhagia differs from these smaller irregularities. Menorrhagia is a condition where women consistently experience abnormally long and heavy menstrual flows that can affect their ability to complete daily activities. Menorrhagia is usually accompanied by severe menstrual cramps making the combined pain and blood loss difficult to go about life normally when on your period. If menorrhagia is left untreated, it can lead to anaemia (iron deficiency) which can have several negative effects on the body; the main two being tiredness and shortness of breath.

Menorrhagia is most common in adolescence and around menopause. If you find that you dread your period because of extreme menstrual bleeding and cramps, make sure to talk to your doctor to determine an effective treatment method. Your doctor will most likely be able to identify if you have menorrhagia or metrorrhagia, another condition that causes heavy menstrual bleeding. Metrorrhagia is different to menorrhagia as it involves spotting or heavy bleeding between periods. Some women experience menometrorrhagia which is a combination of both conditions.

Causes of menorrhagia

The main causes of menorrhagia are problems or conditions that can affect the uterus resulting in heavy bleeding. These may include:

• Use of intrauterine device (IUD)
• Uterine fibroids
• Hormonal imbalance (PCOS)
• Menstrual cycles without ovulation (anovulation)
• Ectopic pregnancy and other pregnancy complications
• Uterine polyps
• Adenomyosis
• Medications
• Von Willebrand disease and other heritable bleeding disorders
• Uterine (endometrial) and cervical cancer
• Liver, thyroid and kidney disease

Symptoms of menorrhagia

If you have menorrhagia, your periods and cramps are so heavy that they affect your ability to complete daily tasks. The below symptoms may indicate that you have menorrhagia if you can identify with them:

• Soaking through one or more pad or tampon every hour or two for several hours consecutively
• Using double sanitary protection to control bleeding
• Waking up to change sanitary products during the night
• Bleeding for more than a week
• Passing blood clots, the size of a quarter (Australian $1 coin) or larger
• Restricting daily activities due to high menstrual flow
• Symptoms of anaemia (iron deficiency) including tiredness and shortness of breath paired with extremely heavy bleeding
• Severe and painful menstrual cramps paired with extremely heavy bleeding

Diagnosis of menorrhagia

To diagnose menorrhagia, a doctor may ask you about your menstrual health and contraception. To help identify your condition, you may be asked to track your period by keeping a diary of symptoms that include information on the severity of your bleeding, clotting and cramping. In some cases, your doctor may want to conduct further testing to identify the underlying cause. Some tests to help identify menorrhagia include:

• Blood tests (to identify hormonal levels, thyroid function, iron deficiency, clotting and pregnancy problems).
• Transvaginal ultrasound (to find uterine anomalies such as fibroids and ectopic pregnancy).
• Ultrasound of the uterus (to look for fibroids, polyps and malignant lesions).
• Pap test (identify cervical changes such as infection, inflammation or cancer).
• Endometrial biopsy (to check for abnormal tissue or cancer in the uterine lining)
• Hysteroscopy (to further analyse the uterine lining and cavity as well as retrieve a lost IUD)
• Liver function tests (to detect liver disease)
• Kidney disease tests (to detect kidney disease)

Treatment of menorrhagia

To determine an appropriate treatment for menorrhagia, your doctor will analyse the underlying cause of your condition whilst also considering your age, overall health, and personal preferences.

First line treatments for menorrhagia include:

• Birth control pills – stop ovulation and result in lighter menstrual flow
• Prostaglandin inhibitors (NSAIDs) – oral medication used to reduce cramping and menstrual blood flow
• Oral progesterone – can help regulate hormone levels
• Hormonal IUD – release progestin thin out the uterine lining, which can reduce blood flow and cramping
• Tranexamic acid – oral medication that promotes blood clotting which may help slow the flow of blood
• Iron supplements – if blood loss has caused iron deficiency

When medical treatments don’t work or aren’t suitable, surgical treatments may be considered for the patient. These may include:

• D&C (dilation and curettage) removal of tissue from the uterine lining
• Uterine artery embolization – shrinking fibroids
• Myomectomy – removal of fibroids
• Endometrial ablation or endometrial resection – destroying the uterine lining (only performed on people who do not intend on becoming pregnant)
• Hysterectomy – the removal of the uterus and in some cases the ovaries (only performed on people who do not intend on becoming pregnant)

For cases where cancer or an underlying disease is detected resulting in menorrhagia, your doctor will refer you to a specialist such as an oncologist, nephrologist or hepatologist for further evaluation and treatment.

Menorrhagia affects many women worldwide. If you dread your period every month because of extreme menstrual bleeding and cramps, make sure to talk to your doctor to determine an effective diagnosis and treatment method.

Medical Disclaimer: Articles are intended for informational purposes only and should not be used as the basis of patient treatment. Ask a medical professional if you have any health-related questions or concerns.

Additional Resources

Johns Hopkins Medicine. (n.d.). Menorrhagia. https://www.hopkinsmedicine.org/health/conditions-and-diseases/menorrhagia

Mayo Clinic. (2022). Menorrhagia (heavy menstrual bleeding). https://www.mayoclinic.org/diseases-conditions/menorrhagia/symptoms-causes/syc-20352829

Whelan, C. (2021). What is menorrhagia and is it dangerous?https://www.healthline.com/health/menstruation/menorrhagia