Heavy Period (Menorrhagia) – Causes & Treatment

What is Menorrhagia?

Menorrhagia is when a woman experiences abnormally heavy or prolonged bleeding during menstrual periods. A woman can accept that she is having heavy or prolonged bleeding when her period lasts longer than seven days or she loses more blood than is typical during normal menses. Some women may even pass out blood clots. Heavy or prolonged period bleeding is a common issue and affects 27%-54% of females worldwide. 

Signs and Symptoms of Menorrhagia 

Usually, women who experience heavy or prolonged bleeding will have signs and symptoms as below:

1. Soaking through more than one sanitary pad in an hour for a few consecutive hours 
2. Need to wake up during sleep to change sanitary pads
3. Menstrual period lasts longer than 7 days
4. Passing out blood clots that size bigger than a quarter
5. Symptoms of anemia, such as dizziness, getting tired easily, fatigue, shortness of breath

Anyone who experiences the above symptoms needs to seek medical help as soon as possible.

What causes heavy or prolonged menstrual bleeding?

In some cases, the cause of menorrhagia is unknown. But most of the time, menorrhagia is due to the causes below:

• Hormone imbalance: When there is an imbalance between estrogen and progesterone hormone, it will cause the endometrium to develop in excess and eventually lead to heavy menstrual bleeding. Hormone imbalance could easily be due to polycystic ovary syndrome (PCOS), obesity or thyroid problems.
• Uterine fibroids: Uterine fibroid is a benign tumor of the uterus which may cause heavier bleeding than normal menstrual cycle.
•  Polyps: Small and benign growths on the lining of uterus will cause heavy or prolonged menstrual bleeding 
• Post intrauterine device insertion: One of the side effects for non-hormonal intrauterine devices is Menorrhagia
• Cancer: Uterine or cervical cancer can cause heavy bleeding, especially if happen in postmenopausal women
• Infections like sexually transmitted disease 
• Bleeding disorders: Some bleeding disorders will cause abnormal menstrual bleeding due to a lack of blood clotting factor
• Medications: Certain medications will cause heavy or prolonged menses; for example anticoagulants or hormonal pills (contraceptives) 
• Other medical conditions: liver or kidney diseases

What test will be done to diagnose heavy or prolonged menstrual bleeding?

1. Blood test: blood will be drawn to look for anemia, thyroid problems, clotting issues and infection
2. Pap smear test: To look for any abnormal or suspicious cell in the cervical region 
3. Endometrial biopsy: A sample will be taken from uterus and sent to the lab to look for any abnormality 
4. Ultrasound: A scan that will be performed by the doctor to look for any mass/abnormality in uterus, ovaries or pelvis 

Based on the result of the initial test, the doctor will decide whether to further investigate. If further investigation is required, the doctor will proceed with the test below:

1. Hysteroscopy: This test requires inserting a thin and light instrument through the vagina and cervix to look for any abnormality inside the uterus
2. Sonohysterography: Fluid will be injected through a tube into the uterus and the doctor will perform an ultrasound to look for any problems in the lining of the uterus.

Treatment for Menorrhagia 

Medications:

• NSAIDs: NSAIDs can help to reduce menstrual blood loss and reduce the painful cramps sensation
• Tranexamic acid: Tranexamic acid helps to reduce bleeding. It is only to be taken if there is bleeding 
• Oral Contraceptives pills: Hormone pills help to regulate hormone and menses, thus, it helps to reduce episodes of prolonged bleeding 
• Hormonal intrauterine device: This device can make the uterine lining become thinner and decrease menstrual blood flow and cramping.

If medical therapy cannot cure menorrhagia, surgical intervention may be needed:

• Dilation and curettage (D&C): the doctor will dilate the cervix and scrape tissue from the lining of the uterus to reduce menstrual bleeding. You may need additional D&C procedures if Menorrhagia recurs
• Uterine artery embolization: this is basically burning the uterine artery to reduce/shrink the size of fibroid 
• Myomectomy: this is a surgical procedure that removes uterine fibroids
• Endometrial ablation: this involves destroying the lining of uterus via a surgical procedure as well 
• Endometrial resection: this is a surgical procedure to remove the lining of the uterus, whether whole, or in part 
• Hysterectomy: this is the surgical removal of the uterus and cervix. This is a permanent procedure that will cause sterility and end menstrual periods.