Understanding Menorrhagia (Heavy Menstrual Bleeding): Causes, Symptoms, and Treatment

What is Heavy Menstrual Bleeding (Menorrhagia)?

Formerly known as menorrhagia, heavy menstrual bleeding is a condition due to which you have extremely heavy or prolonged bleeding. This typically means your periods last for over seven days. It can also refer to periods when you lose more blood than usual.

In this condition, you may bleed so heavily that you need to change your pad or tampon every hour for several hours and may pass blood clots the size of small coins. This type of heavy menstrual bleeding often interferes with your daily life.

How Common are Heavy Periods?

Heavy menstrual bleeding is relatively common and can affect about 27 to 54% of women who menstruate.

Is Heavy Menstrual Bleeding Serious?

Menorrhagia or heavy menstrual bleeding can become severe at times when you lose too much blood and begin to display signs of anaemia. Anaemia is when you have too little iron in your body. Without the proper treatment, anaemia can also be life-threatening. Some conditions like cancer that cause heavy menstrual bleeding can also be life-threatening.

What are the Signs and Symptoms of Heavy Menstrual Bleeding?

Heavy menstrual bleeding symptoms include:

• Pain in the abdomen
• Periods that last for over seven days
• Clots in the blood that appear pink, red, brown, or rust colour
• Bleeding through pads or tampons every hour for more than 2 hours
• Symptoms of anaemia like exhaustion, shortness of breath, and fatigue
• Losing over 80 millilitres of blood during your period as compared to the standard 30 to 40 millilitres

Pica, another condition with anaemia, can also be a heavy menstrual bleeding symptom in which you may notice a loss of hair, pale skin, and a desire to consume nonfood items.

How Do You Know If You Have Heavy Menstrual Bleeding?

Heavy menstrual bleeding can hamper your quality of life. Many women have the misconception that periods are supposed to be uncomfortable and inconvenient. They may have even watched family members live with this condition without seeking help. However, regular periods should not affect your daily routine. You should be able to:

• Use a standard-size tampon or pad for 3 or 4 hours without needing a change.
• It would be best if you did not have to wear two pads or two tampons at any time.
• Leave your house for a bit without carrying multiple packets of pads or a change of clothes.
• Live your everyday life without missing work or avoiding activities you like because of a fear of going out.

How Long Does Heavy Menstrual Bleeding Last?

How long your heavy menstrual bleeding lasts depends on what is the cause of your condition. Typically, heavy menstrual bleeding symptoms last for more than seven days.

What Causes Heavy Menstrual Bleeding?

Take a closer look at the multiple heavy menstrual bleeding causes:

Hormone imbalances

Hormones like estrogen and progesterone help regulate your menstrual cycle. Conditions that cause hormonal imbalance, like anovulation, thyroid disease, and polycystic ovary syndrome, also lead to heavy period bleeding. Being overweight or more than your ideal weight can also lead to hormone imbalance and heavy menstrual bleeding.

Non-cancerous Growths in Your Uterus

Non-cancerous or benign growths in your uterus or conditions that cause the cells in your uterus to grow improperly can also be a menstrual bleeding cause. This can include:

• Fibroids
• Adenomyosis
• Polyps

Cancerous Growths in Your Uterus

Conditions like endometrial hyperplasia that can increase the risk of cancer, as well as cancers like Uterine and Cervical cancer, can affect your reproductive system, thus causing heavy menstrual bleeding.

Infection

Sexually transmitted infections can also cause heavy menstrual bleeding with clots. This includes:

• Gonorrhea
• Chlamydia
• Trichomoniasis
• Chronic endometritis

Pregnancy Complications

Heavy menstrual bleeding can also be a result of complications with your pregnancy, like a miscarriage or ectopic pregnancy. A C-section niche, which is a scar that creates a pocket in your uterus when you have a high number of cesarean sections, can also collect blood, which later bleeds.

Other Medical Conditions

Heavy menstrual bleeding can be a symptom of an underlying condition that can include non-bleeding and bleeding conditions. Some of the common conditions that lead to heavy bleeding include:

• Liver disease
• Von Willebrand disease
• Leukaemia or other platelet disorders
• Pelvic Inflammatory Diseases (PID)

Medications

Many medicines can also cause menorrhagia or heavy menstrual bleeding cause. These medications include:

• Hormone replacement therapy
• Blood thinners and aspirin
• Intrauterine Devices (IUDs)
• Tamoxifen, a breast cancer drug
• Birth control pills and injectables

Not removing a contraceptive device on time can also cause abnormally heavy menstrual bleeding.

How is Heavy Menstrual Bleeding Diagnosed?

You may need to answer questions to help your healthcare provider understand your medical and menstrual cycle history. They may want to know:

• The age at which you got your first period
• How long do your periods last
• How many days you have heavy bleeding
• Any family members who have heavy menstrual bleeding
• History of pregnancy and birth control
• Any medications you are currently taking

They may even ask you about whether you are doubling down on menstrual products, avoiding any activities during your periods or restricting yourself in any way.

What Tests Will be Done to Diagnose Heavy Menstrual Bleeding?

After doing a physical and pelvic examination, your doctor may suggest non-invasive tests such as:

• A sonohysterogram
• Hysteroscopy

They may even suggest diagnostic tests like:

• A blood test for anaemia (CBC), thyroid disease (TSH), or clotting issues [prothrombin time (PT) test]
• A Pap smear
• Endometrial biopsy
• Transvaginal ultrasound
• Magnetic Resonance Imaging (MRI)
• Cervical test for infection

How is Heavy Menstrual Bleeding Treated?

Your heavy menstrual bleeding treatment depends on the underlying heavy menstrual bleeding cause. The treatment will also depend on your preference and how you respond to different medications. If you plan on getting pregnant, it also affects your heavy menstrual bleeding treatment options.

Medications Used to Treat Heavy Menstrual Bleeding

The most commonly used medicines for heavy menstrual bleeding include:

• Iron supplements
• Nonsteroidal Anti-Inflammatory Drugs
• Birth control
• Hormone therapy
• Gonofotropin-releasing hormone antagonists
• Antifibrinolytic medicines
• Desmopressin nasal spray

Procedures Used to Treat Heavy-Period Bleeding

One of the most commonly used procedures for heavy menstrual bleeding treatment is a hysteroscopy. Along with this, other procedures include:

• Myomectomy
• Endometrial ablation
• Uterine artery embolization (UAE)
• Hysterectomy

How is Heavy-Period Bleeding Managed?

Your doctor will first start with medication before moving on to minor procedures or surgeries to manage your heavy menstrual bleeding.

How is Heavy-Period Bleeding Prevented?

Although you cannot prevent heavy menstrual bleeding, timely diagnosis and treatment can help you better manage the symptoms.

What is the Prognosis for Living with Heavy Menstrual Bleeding?

If menorrhagia or heavy menstrual bleeding is left untreated, it can cause life-threatening conditions like anaemia. However, with proper treatment, you can manage the heavy menstrual bleeding symptoms and live an uncompromised life.

When Do You Call Your Doctor If You Suspect Heavy Period Bleeding?

If you are experiencing any symptoms of heavy menstrual bleeding or signs you are losing too much blood during periods, it is advisable to call your doctor immediately. Tracking your periods with an app also helps you identify longer than usual or heavier periods. You can share the details from the app with your doctor to help them make a more informed decision.

Can Heavy Menstrual Bleeding be Life-Threatening?

While menorrhagia is not usually life-threatening, it can be if you lose too much blood.

Conclusion

Heavy menstrual bleeding is not normal, and it is essential to ensure you visit the doctor to help relieve your symptoms. If your periods are coming in the way of your mental and physical well-being, you need to speak to your healthcare provider to find out the reason behind it. Keeping a check on your haemoglobin levels by getting regular health checkups at reliable diagnostic centres like Metropolis Labs helps you understand if you are anaemic. Book your appointment today.