Menorrhagia is the medical term for excessive bleeding at the time of the menstrual period, either in number of days or amount of blood or both.
Almost every woman at some time in her reproductive life experiences heavy bleeding during her menstrual period. Some women have heavy periods almost every cycle. Menorrhagia - the Greek roots men meaning "month" and rhegnynai meaning "to burst forth" - is the medical term for excessive or prolonged menstrual bleeding or both. The condition is also known as hypermenorrhea.

The menstrual cycle isn't the same for every woman. Normal menstrual flow occurs about every 28 days, lasts four to five days and produces a total blood loss of 60 to 250 milliliters (4 tablespoons to about 1 cup). Your period may be regular or irregular, light or heavy, painful or pain-free, long or short and still be considered normal.

Although about one-third of premenopausal women complain of heavy menstrual bleeding, only one in 10 women experience blood loss severe enough to be defined as Menorrhagia. Some women with Menorrhagia often find it necessary to miss time at work, school or social activities, due to the severity of their symptoms.

Signs and symptoms

The signs and symptoms of menorrhagia include:

• Menstrual flow that soaks through one or more sanitary pads or tampons every hour for several consecutive hours

• The need to use double sanitary protection to control your menstrual flow

• The need to change sanitary protection during the night

• Menstrual period that lasts longer than seven days

• Menstrual flow that includes large blood clots

• Heavy menstrual flow that interferes with your regular lifestyle

• Constant pain in the lower abdomen during menstrual period

• Irregular menstrual periods

• Tiredness, fatigue or shortness of breath (symptoms of anemia)

Causes

In some cases the cause of heavy menstrual bleeding is unknown, but a number of conditions may cause menorrhagia. Common causes include:

• Hormonal imbalance. In a normal menstrual cycle, a balance between the hormones estrogen and progesterone regulates the buildup of the lining of the uterus (endometrium), which you shed during menstruation. If a hormonal imbalance occurs, the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding. Hormonal imbalance occurs most often in adolescent girls experiencing their menstrual periods for the first time or in women approaching menopause. Menorrhagia caused by certain conditions involving hormonal imbalance, such as thyroid disease, often can be controlled with hormone medications. However, improper use of hormone medications can be a direct cause of menorrhagia.

• Uterine fibroids. These noncancerous (benign) tumors of the uterus appear during your child-bearing years. Uterine fibroids may cause heavier-than-normal or prolonged menstrual bleeding.

Together, hormonal imbalance and uterine fibroids account for about 80 percent of all cases of menorrhagia. Other causes may include:

• Polyps. The development of small benign growths on the uterine wall (uterine polyps) may cause heavy or prolonged menstrual bleeding. Polyps of the uterus most commonly occur in women of reproductive age as the result of excessive hormone production or consumption and can lead to bleeding not associated with menstruation (spotting).

• Ovarian cysts. These fluid-filled sacs or pockets occur within or on the ovary. Ovarian cysts are often benign and rarely cause menstrual irregularities, including menorrhagia.

• Dysfunction of the ovaries. Failure of the ovaries to produce, mature or release eggs (anovulation) may cause hormonal imbalance and result in menorrhagia.

• Adenomyosis. This condition occurs when glands from the endometrium become embedded in the uterine muscle, often causing heavy bleeding and pain. Adenomyosis is most likely to develop if you're a middle-age woman who has had many children.

• Intrauterine device (IUD). Menorrhagia is a well-known side effect of using an intrauterine device for birth control. When an IUD is the cause of excessive menstrual bleeding, you'll often need to remove it. Light spotting is normal with the use of an IUD and, with no other symptoms present, is most likely insignificant.

• Pregnancy complications. A single heavy period that's late may be due to a miscarriage. If bleeding occurs at the usual time of menstruation, however, miscarriage is less likely to be the cause. An ectopic pregnancy, implantation of a fertilized egg within the fallopian tube instead of the uterus, also may cause menorrhagia.

• Cancer. Rarely, certain female reproductive cancers may cause menorrhagia. Uterine cancer, ovarian cancer and cervical cancer can cause excessive vaginal bleeding.

• Medications. Certain drugs, including those that prevent the clotting of blood (anticoagulants) and anti-inflammatory medications, can contribute to heavy or prolonged menstrual bleeding.

• Other medical conditions. A number of other medical conditions may cause or increase your risk of menorrhagia. Pelvic inflammatory disease (PID), thyroid problems, endometriosis, lupus, liver or kidney disease, some uncommon blood disorders, certain cancers and chemotherapy may cause menorrhagia.

Risk factors

Any woman at any time in her reproductive life may experience heavy menstrual bleeding. Young women who aren't yet ovulating regularly may be especially prone to menorrhagia in the first 12 to 18 months after their first menstrual period (menarche). Older women approaching menopause often experience hormonal imbalance that can cause menorrhagia. Women at higher risk also include those with hereditary bleeding disorders.

When to seek medical advice

Doctors generally recommended that all sexually active women and women over the age of 18 have yearly pelvic exams and regular Pap tests. However, if you experience irregular vaginal bleeding, schedule an appointment with your doctor and be certain to record when the bleeding occurs during the month. If you're having heavy vaginal bleeding — soaking at least one pad or tampon an hour for more than a few hours — seek medical help. Call your doctor if you have severe menstrual pain that doesn't respond to at-home treatment or if you have vaginal bleeding after menopause.

Screening and diagnosis

Your doctor will most likely ask about your medical history and menstrual cycles. You may be asked to keep a diary of bleeding and nonbleeding days including notes on how heavy your flow was and how much sanitary protection you needed to control it. Your doctor will do a physical exam and may recommend one or more tests or procedures such as:

• Blood tests. A sample of your blood is evaluated for any abnormalities due to excessive blood loss during menstruation.

• Pap test. Your doctor collects cells from your cervix for microscopic examination to detect infection, inflammation, or changes that may be cancerous or may lead to cancer.

• Endometrial biopsy. Your doctor takes a sample of tissue from the inside of your uterus to be examined under a microscope.

• Ultrasound scan. This method scan uses sound waves to produce pictures of your uterus, ovaries and pelvis.

• Sonohysterogram. This ultrasound scan is done after fluid is injected through a tube into the uterus by way of your vagina and cervix. This allows your doctor to look for problems in the lining of your uterus.

• Hysteroscopy. A tiny tube with a light inserted through your vagina and cervix into the uterus allows your doctor to see the inside of your uterus.

• Dilation and curettage (D and C). In this procedure, your doctor opens (dilates) your cervix and then inserts a spoon-shaped instrument (curette) into your uterus to collect tissue from the lining of your uterus to be examined in the laboratory.

• Hysterosalpingography. A dye is injected into your uterus and fallopian tubes through the cervix, and X-rays are taken to determine the shape and size of your uterus and fallopian tubes.

Doctors can be certain of a diagnosis of menorrhagia only after ruling out other menstrual disorders, medical conditions or medications as possible causes or aggravations of the condition.

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