Heavy Periods (Menorrhagia) Causes, Diagnosis, and Treatment

What is menorrhagia?

Heavy periods, also known as menorrhagia, are a common phenomenon in most women, and the majority have no known cause. It is quite difficult to ascertain if your periods are heavy or normal compared to that of other women. Some people who believe they have a heavy period actually experience an average loss of blood. While some others who think they have a normal period actually experience heavy loss of blood. In most cases, the blood flow is experienced in the initial days (3) of the period.

Accurate measurement of blood loss is sometimes difficult. General accepted blood loss during periods is categorised into:

• Normal period: This is when the blood loss of an individual is between 30 – 40ml every month. On average, the bleeding lasts 5 days but may also last 8 days.
• Heavy periods: This is when the blood loss of an individual is around 80ml or above in each cycle.

However, measuring the blood loss during your period might be difficult.

Symptoms of menorrhagia

Your period is considered heavy if you experience one or more of the following:

• If you require a doubling of your sanitary protection (towels and tampons)
• Bleeding through your sanitary protection to your beddings or clothes
• Large blood clots
• Soaking bedclothes
• Frequent changing of tampons or sanitary pads (changing tampons or pads every hour)
• Disturbing your regular lifestyle due to heavy bleeding

Menorrhagia are heavy periods that occur every month, and the loss of blood interferes with your everyday life. An example of this is when your regular activities, such as shopping, working, or hanging out with friends, are affected by your heavy periods. Menorrhagia may occur with symptoms or alone.

Causes of menorrhagia

There is often no definite reason for menorrhagia, but sometimes, a cause may be found.

Known cause of menorrhagia

• Womb conditions such as polyps (tiny fleshy lumps), endometriosis, endometrial cancer (cancer of the womb lining), and womb infections
• Fibroids: This benign (non-cancerous) growth occurs in the womb's muscle. They may sometimes pose no threat but can be responsible for heavy periods. Fibroids commonly affect females of Afro-Carribean descent and women aged 30 to 50
• Hormonal problems: Women may have heavy or irregular periods if they don't ovulate regularly. This is common in women with PCOS (polycystic ovary syndrome). Also, women may have heavy periods if they have an underactive thyroid gland
• Pelvic infections: Various infections can cause heavy periods, such as chlamydia or Pelvic inflammatory disease. Some of these infections caused by bacteria can be treated using antibiotics
• Some medications used in chemotherapy can lead to heavy periods
• Bleeding disorders, also known as blood clotting disorders may cause heavy bleeding. One such disorder is the von Willebrand, and you may also notice other symptoms apart from heavy bleeding, such as bleeding from other body parts and easy bruising
• Intrauterine contraceptive device: The IUCD is a contraceptive commonly called a copper coil and may be responsible for heavy bleeding. However, the IUS (intrauterine system) that releases hormones can actually manage this situation and reduce the heavy blood loss
• Warfarin or blood clotting medications: If you are taking medications like this, you may experience heavy periods as a side effect

Unknown Cause

If the reason for your heavy period is unknown, it is known as idiopathic menorrhagia or dysfunctional uterine bleeding. This is very common, and in this situation, the ovaries and uterus are normal and are not a result of hormonal imbalances. People with this experience normal ovulation and regular periods.

Heavy periods caused by dysfunctional uterine bleeding are experienced more often in the initial years when you start having periods and also towards your menopause. During these times, your periods are heavy and often irregular. There is a possibility that the period of heavy periods in teenagers may decrease after a couple of years. However, if you experience pain during your periods, that may indicate endometriosis, so it is advisable to seek a medical expert for further investigations.

When should you see your healthcare provider about your heavy periods?

You should seek medical advice if you notice a sudden change in your periods and it has become heavier than before. This should be after observing for 3 to 4 periods in a row. It is normal to sometimes notice a little difference in your periods, and it later goes back to the usual. Most women with heavy periods have no known cause, and there is no abnormality of hormones or the womb.

Also, if you suddenly start looking pale or feeling dizzy, tired, faint during these heavy periods, you should seek medical intervention. This might indicate that the bleeding is too much and can cause anaemia.

Diagnosis and Tests

How is Menorrhagia Diagnosed?

To diagnose menorrhagia, your healthcare provider will ask about your medical history and menstrual cycle. A physical and pelvic exam will also be conducted.

Your provider may ask questions about:

• The age when you had your first period
• The duration and heaviness of your periods
• Any family history of heavy menstrual bleeding
• Your pregnancy history and current birth control methods
• Medications you're taking, including over-the-counter options

Additionally, your provider will discuss how menorrhagia affects your daily life, such as whether you need to use multiple menstrual products, avoid activities, or make lifestyle adjustments due to heavy bleeding.

Tests for Diagnosing Menorrhagia

A pelvic ultrasound is the most common diagnostic tool for menorrhagia. Depending on your age and symptoms, additional tests may include:

• Blood tests to check for anaemia, clotting disorders, or thyroid issues
• Transvaginal ultrasound to assess pelvic organs and tissues
• Magnetic resonance imaging (MRI) to examine uterine abnormalities if ultrasound results are inconclusive
• Pap smear to detect abnormal cervical cells that may indicate cancer
• Cervical culture to test for infections
• Endometrial biopsy to check uterine tissue for cancer or irregularities

Other diagnostic procedures may include:

• Sonohysterogram (saline-infusion sonography): Uses saline to assess the uterine lining for abnormalities
• Hysteroscopy: Uses a thin, lighted tube to examine the uterus for fibroids, polyps, or other irregular tissue. Growths causing heavy bleeding may also be removed during this procedure

Management and Treatment

Best Treatments for Menorrhagia

Treatment depends on the underlying cause, severity of bleeding, age, and overall health.

In some cases, menorrhagia may improve without medical intervention, particularly if caused by mild hormonal imbalances or weight-related factors. However, for many individuals, treatment is necessary to manage symptoms effectively.

Discuss your health concerns and treatment goals with your provider to determine the best approach.

Medications for Heavy Menstrual Bleeding

Before considering surgery, healthcare providers often recommend medications, including:

• Iron supplements to prevent or treat anaemia
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin to reduce cramps and bleeding
• Hormonal contraceptives (pills, vaginal rings, patches, IUDs) to regulate menstrual cycles and reduce blood flow
• Hormone replacement therapy (HRT): Helps balance oestrogen and progesterone levels, especially in perimenopausal individuals
• Gonadotropin-releasing hormone (GnRH) agonists and antagonists: Temporarily reduce or stop menstrual bleeding
• Desmopressin nasal spray (Stimate®): Helps with clotting in individuals with von Willebrand disease
• Antifibrinolytic medications (e.g., tranexamic acid): Prevent excessive breakdown of blood clots to reduce bleeding

Surgical Procedures for Menorrhagia

If medications do not effectively manage symptoms, your provider may recommend a surgical procedure based on the cause of your heavy bleeding:

• Hysteroscopy: Diagnoses and removes polyps or fibroids inside the uterus
• Dilation and curettage (D&C): Removes the outer layer of the uterine lining; tissue may be analysed for underlying causes
• Myomectomy: Removes uterine fibroids while preserving fertility
• Uterine artery embolization (UAE): Reduces blood supply to fibroids and other tumours
• Endometrial ablation: Destroys part or all of the uterine lining to reduce or stop periods
• Hysterectomy: Surgically removes the uterus, permanently stopping menstruation and eliminating the possibility of pregnancy

Treatment typically begins with medication and may progress to minor or major surgical options, depending on effectiveness. Discuss your options with your healthcare provider to find the best solution.

Frequently Asked Questions

What Happens if Menorrhagia is Left Untreated?

Untreated heavy menstrual bleeding can lead to anaemia, which may cause fatigue, dizziness, and other health complications. Seeking medical attention is essential if you suspect menorrhagia.

Can Menorrhagia Resolve Without Treatment?

Yes, menorrhagia can sometimes resolve on its own, particularly if it is due to temporary hormonal fluctuations. However, in many cases, an underlying condition is responsible, and medical treatment is required for lasting relief.

If you are experiencing persistent heavy menstrual bleeding or are concerned about menorrhagia, contact us today for expert advice and personalised care.