Menorrhagia (Heavy or Extended Menstrual Bleeding)
What is menorrhagia?
Menorrhagia is menstrual bleeding that lasts longer than 7 days or bleeding that is much heavier than usual, possibly with large clots. If you have unusually heavy bleeding for 2 menstrual periods in a row, you should talk to your healthcare provider about it.
How does it occur?
There are many possible causes of menorrhagia, including:
- hormone imbalance, the most common cause (the imbalance is sometimes caused by improper use of hormone medicine)
- polyps, which are growths on the cervix (the opening of the uterus) or inside the uterus; polyps are usually noncancerous
- fibroids, which are usually noncancerous growths in the uterus
- endometriosis (uterine tissue growing outside the uterus)
- a cyst (a sac full of fluid or blood) on the ovary
- use of an IUD (intrauterine device) or birth control pills
- cancer of the uterus or ovary and sometimes cancer of the cervix or vagina
- chronic medical problems (for example, thyroid problems, diabetes, and blood-clotting problems)
- some medicines, such as blood thinners
- stress
How is it diagnosed?
Your healthcare provider will ask about your medical history and menstrual cycles. Your provider may ask you to keep a diary of bleeding and nonbleeding days, including notes about how heavy the bleeding was. You will also have a physical exam.
You may need a blood test or procedure, such as:
- Endometrial biopsy: Your healthcare provider takes a sample of tissue from the inside of the uterus. The tissue is examined under a microscope.
- Ultrasound scan: Sound waves are used to get pictures of the uterus, ovaries, and pelvis. The ultrasound probe may be placed on your lower abdomen or into your vagina.
- Sonohysterogram: An ultrasound scan is done after fluid is placed through a tube into your uterus. This test allows your provider to look for problems with the lining of the uterus, such as fibroids or polyps.
- Hysteroscopy: Your healthcare provider inserts a thin metal tube with a light and tiny camera through the vagina and cervix and into the uterus. This allows your provider to see the inside of the uterus.
- Laparoscopy: Your healthcare provider inserts a thin metal tube with a light and tiny camera into your abdomen and pelvis through a small cut in or just below your bellybutton. Your provider uses the scope to look at your uterus and other pelvic organs.
- D&C (dilation and curettage): Your healthcare provider opens up the cervix and scrapes or suctions tissue from the lining of the uterus. The tissue is examined in the lab.
- Hysterosalpingography: Dye is injected into the uterus and fallopian tubes through the cervix. X-rays are then taken. The dye outlines the shape and size of the uterus and tubes.
Many of these procedures may be done in your healthcare provider's office. Others may be done in an outpatient clinic.
How is it treated?
The treatment depends on the cause of the problem. For example, if it is caused by an IUD, the IUD will be removed. If you have a hormone imbalance, your healthcare provider may prescribe hormones.
Taking a nonsteroidal anti-inflammatory drug, such as ibuprofen, may help control heavy bleeding.
Sometimes surgery is needed. Possible surgical treatments include:
- D&C: in which tissue is scraped or suctioned from the uterus
- Hysteroscopy: to remove a polyp, for example
- endometrial ablation: which is the use of a laser, electrocautery instrument, thermal balloon, or microwave energy to destroy the inside lining of the uterus
- hysterectomy: which is removal of the uterus
Hysterectomy and endometrial ablation are procedures that will cause you to be sterile, that is, unable to become pregnant. If you have a hysterectomy, you will stop having menstrual periods. After endometrial ablation you should have no or very little menstrual flow, although some women start having menstrual flow again a while after the procedure.
How long will the effects last?
How long you have heavy or extended menstrual bleeding depends on the cause and treatment.
How can I take care of myself?
- Follow the treatment recommended by your healthcare provider.
- Avoid taking aspirin because it could make you bleed more.
- Rest more during your period. Put your feet up and avoid heavy manual work.
- Keep a record of how many sanitary pads or tampons you use by the hour and each day.
- Eat a healthy diet, low in fat and high in iron.
- Keep a healthy weight. If you are overweight, try to gradually lose some weight.
- Get regular exercise when you are not having your period.
- Practice relaxation techniques, such as yoga and meditation.
Written by Anthony Angello, MD.
Published by RelayHealth.
© 2009 RelayHealth and/or its affiliates. All Rights Reserved.
