Menorrhagia is heavy menstrual bleeding. It can be caused by hormone problems or problems with the uterus.
A doctor will ask questions about your health history and about your menstrual cycle. They will also do a pelvic exam and a pap test.
A doctor can treat Menorrhagia with medications or surgery. Surgery is usually done on an outpatient basis.
Diagnosis
While it’s normal to have light spotting between periods during puberty and during pregnancy, women with heavy bleeding should consult their doctor. Heavy menstrual periods can be a sign of uterine or hormonal problems, and there are treatments available to help. Heavy menstrual bleeding can interfere with a woman’s daily activities, and it can lead to anemia or other health concerns.
To diagnose a woman with menorrhagia, her doctor will ask her to describe her symptoms and medical history. She may recommend keeping a diary of her menstrual cycle, including the length and severity of the bleeding. The doctor will also perform a pelvic exam.
If the patient is not pregnant, she will probably have a blood test to check for anemia and for any other causes of bleeding, such as thyroid or clotting disorders. She may also have a pap test, or colposcopy, which involves taking samples of cells from the cervix to look for signs of cancer or other abnormalities.
In some cases, a gynecologist will use a special tool to view the inside of the uterus, called a hysteroscopy. During this procedure, the doctor can remove the lining of the uterus if it is too thick and can also treat the cause of the bleeding. Other diagnostic tools include the saline infusion sonohysteroscopy, which is less invasive than a hysteroscopy.
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Other treatment options for menorrhagia include hormone therapy and medicines to control pain. These medications can reduce the intensity and frequency of period symptoms, but they won’t necessarily stop the bleeding. If the bleeding is caused by a uterine tumor or another serious condition, it may be necessary to have surgery. In some cases, a hysterectomy can eliminate the need for menstrual bleeding by removing the uterus, cervix and sometimes the ovaries. In other cases, doctors can use a surgical technique called focused ultrasound ablation to destroy fibroid tissue and stop the heavy menstrual bleeding. If that doesn’t work, a myomectomy can be done to remove the fibroid tumor. If these options fail, a woman may need a hysterectomy to stop the bleeding.
Medications
A person may be diagnosed with menorrhagia if she experiences severe, abnormal bleeding during her period. Heavy blood loss can make it hard to carry out everyday tasks and can cause anemia, which causes fatigue and weakness. Fortunately, there are effective treatments for heavy periods that help alleviate symptoms and treat the underlying condition.
If a person suspects she has menorrhagia, she should contact her doctor. She will be asked to provide her medical and menstrual history as well as a physical exam. The doctor will also take a sample of the uterine lining to check for an imbalance in hormones or any signs of a malignancy (cancer).
There are several medications that can reduce menstrual bleeding and help treat a person’s underlying problem. Hormone therapy: Taking estrogen and progesterone can balance a person’s hormone levels and decrease menstrual bleeding. Oral contraceptive pills containing both estrogen and progestin are one of the most commonly used forms of medication to treat menorrhagia, although other types of oral contraceptives, such as minipills, can also be helpful. Other hormonal therapies include an estrogen-only ring or implant, or a progestin-only intrauterine device.
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Nonhormonal medications: NSAIDs, such as ibuprofen, can relieve pain and inflammation and decrease the amount of blood lost during a period. Antifibrinolytics, such as tranexamic acid (Cyklokapron), can also help reduce bleeding by slowing down the body’s natural blood-clotting process.
Surgery: If bleeding is caused by fibroids, polyps or a tumor, doctors can surgically remove these growths and restore normal uterine function. In some cases, doctors can also use a procedure called focused ultrasound ablation to destroy or reduce fibroid tissue using ultrasonic waves. This is a less-invasive alternative to myomectomy, which surgically removes the uterus. Other surgeries include endometrial ablation, which uses heat to destroy the lining of the uterus; and hysterectomy, which removes the uterus, cervix and, in some cases, the ovaries.
In addition to treating the underlying cause of menorrhagia, patients should drink plenty of water and eat foods rich in iron to fortify their blood and prevent anemia. They should avoid caffeine, alcohol and smoking, which can all aggravate menstrual symptoms.
Surgery
Depending on the underlying cause of your heavy menstrual bleeding, you may need a surgical procedure to treat it. This could be a dilation and curettage (D&C), in which your doctor scrapes away the abnormal uterine lining; or endometrial ablation, in which he or she uses laser, radiofrequency or heat to destroy the dysfunctional uterine lining. If the menorrhagia is due to an abnormal uterus, such as polyps or fibroids, surgery to remove them might also be necessary.
Your doctor will discuss your treatment options based on the severity of your menorrhagia, age and other factors such as your fertility desires and health history. He or she will also ask about your pain levels and other symptoms and will use a speculum to examine your vagina. A Pap smear may be recommended, and an ultrasound exam will probably be done to view your uterus and pelvic organs.
A full blood picture will be performed to assess your anaemia, and further tests might include thyroid function test or clotting disorder screening. These will help to rule out a number of conditions that can contribute to heavy menstrual bleeding, including chronic endometritis, polycystic ovarian syndrome, uterine fibroids, hyperplasia or cancer.
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Inherited bleeding disorders, such as Von Willebrand disease, can also lead to heavy menstrual bleeding. Pelvic inflammatory disease, an infection of the reproductive organs, can also trigger this problem. Other causes of abnormal uterine bleeding are miscarriage, ectopic pregnancy or a pelvic tumor.
Some women who have heavy periods decide to stop having a period, while others want to reduce the amount of bleeding. Hormonal contraceptive pills can be a good option to control your menstrual flow. Birth control implants or intrauterine devices can also help. If you are seeking a long-term solution to menorrhagia, the levonorgestrel-releasing intrauterine device is an effective and safe treatment that allows future childbearing.
Various surgical options are available for women who have menorrhagia, from simple treatments to the most advanced robotic techniques. A hysterectomy is a serious option for people who don’t want to have more children. However, conservative surgeries such as endometrial ablation can be a reasonable alternative for patients who don’t want to risk major surgery and want to retain their fertility. These procedures are shorter, have lower complication rates and comparable satisfaction rates to hysterectomy.
Lifestyle changes
Women’s periods can vary from one woman to the next and some are accustomed to lighter or heavier bleeding during their period. However, abnormally heavy menstrual bleeding should not be ignored as it could indicate a serious health problem such as uterine fibroids or endometriosis. If left untreated this condition can lead to anemia, which is caused by too much blood loss. Yale Medicine offers a variety of treatments for menorrhagia that can help to ease symptoms and treat any underlying conditions.
The symptoms of heavy menstrual bleeding include having a period that is heavier than normal, soaking through hygiene products (tampons or pads) within an hour of changing them, passing large blood clots during your menstrual cycle and having severe cramps. Some women may also experience bloating, fatigue and weight loss. While many of these symptoms are common, it is important to see your doctor if you notice any of them to get a proper diagnosis.
Oren Zarif
Abnormally heavy menstrual bleeding is caused by a number of factors including problems with the uterus, hormone problems or other diseases and disorders. Some causes of this condition include uterine fibroids, endometriosis or polyps. Other causes include thyroid, kidney or liver disease or other bleeding disorders such as von Willebrand’s disease, which impairs blood clotting.
Heavy menstrual bleeding is not always dangerous, but it can cause anemia and interfere with daily activities. Having a heavy period can be inconvenient and embarrassing for some people, but speaking openly with your doctor and following their treatment plan will allow you to live your life without interruption.
There are a variety of medications and surgical procedures that can be used to treat the symptoms of menorrhagia, depending on the underlying cause. For example, dilation and curettage is a procedure where a surgeon removes the lining of the uterus to reduce menstrual bleeding and uterine artery embolization treats fibroids by blocking the arteries that supply them with blood. Some women may also benefit from hormonal birth control such as progesterone-only pill or an intrauterine system. Yale Medicine’s specialists can help to determine the best treatment options for you based on your specific needs and medical history.
