Heavy menstrual bleeding (Menorrhagia): Causes and treatments

Causes of Menorrhagia

Menorrhagia, or heavy menstrual bleeding, can have various causes. Some of the most common causes include:

1. Hormonal imbalances: Fluctuations in hormone levels during the menstrual cycle can lead to heavy bleeding. Imbalances in estrogen and progesterone levels can cause the uterine lining to grow too thick, resulting in heavy bleeding.
2. Uterine fibroids or polyps: Fibroids are noncancerous growths that develop in or on the uterus, while polyps are small growths that develop on the lining of the uterus. Both can cause heavy or prolonged menstrual bleeding.
3. Adenomyosis: This is a condition in which the lining of the uterus grows into the muscle wall of the uterus. It can cause heavy bleeding, painful periods, and cramping.
4. Endometriosis: Endometriosis is a condition in which the tissue that normally lines the uterus grows outside of it. It can cause heavy menstrual bleeding, as well as pain and infertility.
5. Intrauterine devices (IUDs): Copper IUDs can cause heavier menstrual bleeding in some people.
6. Blood clotting disorders: Conditions that affect blood clotting, such as von Willebrand disease, can cause heavy menstrual bleeding.
7. Thyroid disorders: Hypothyroidism or hyperthyroidism can affect hormone levels and cause heavy menstrual bleeding.

Symptoms of Menorrhagia

Menorrhagia, or heavy menstrual bleeding, is characterized by the following symptoms:

1. Heavy bleeding during periods: Menorrhagia involves bleeding that is significantly heavier than normal, and may require changing tampons or pads every hour or more frequently.
2. Need to change sanitary products frequently: People with menorrhagia may need to change their tampons or pads frequently, even during the night.
3. Passing large blood clots: Menorrhagia can cause the passing of large blood clots, which can be uncomfortable and alarming.
4. Prolonged periods (more than 7 days): Menorrhagia can cause periods that last longer than 7 days.
5. Fatigue and weakness: Heavy menstrual bleeding can cause anemia, which can result in fatigue and weakness.

Diagnosis of Menorrhagia

If you’re experiencing symptoms of menorrhagia, your doctor may perform several tests to help determine the underlying cause. These may include:

1. Medical history and physical exam: Your doctor will ask about your menstrual cycle, including the length of your periods and how often you change tampons or pads. They’ll also perform a physical exam to check for signs of anemia, fibroids, or other abnormalities.
2. Blood tests: Your doctor may order blood tests to check for anemia, thyroid function, and blood clotting disorders.
3. Ultrasound or MRI: These imaging tests can help identify fibroids, polyps, or other abnormalities in the uterus.
4. Biopsy of the uterine lining: Your doctor may perform a biopsy of the uterine lining to check for abnormal cells or other signs of cancer.

Your doctor may also ask you to keep track of your menstrual cycle and record how much you’re bleeding each day. This can help them determine the severity of your bleeding and whether it’s considered menorrhagia.

Treatment options for Menorrhagia

The treatment options for menorrhagia depend on the underlying cause, as well as the severity of your symptoms. Here are some common treatments:

1. Hormonal therapy: This treatment involves using hormones, such as birth control pills, to regulate your menstrual cycle and reduce bleeding.
2. Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications can help relieve menstrual cramps and reduce bleeding.
3. Tranexamic acid: This medication helps to reduce heavy bleeding during periods by preventing blood clots from breaking down.
4. Iron supplements: If you’re anemic due to menorrhagia, your doctor may recommend iron supplements to help boost your iron levels.
5. Endometrial ablation: This is a minimally invasive procedure that uses heat or cold to destroy the lining of the uterus, which can reduce or stop menstrual bleeding.
6. Hysterectomy: This is a surgical procedure to remove the uterus and can be a last resort for people with severe menorrhagia who have completed childbearing.

Pain management for Menorrhagia

In addition to treating the underlying cause of menorrhagia, pain management is an important part of managing the symptoms. Here are some pain management options:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as ibuprofen and naproxen, can help relieve menstrual cramps and reduce bleeding.
2. Heat therapy: Applying heat to the lower abdomen or back can help relieve menstrual cramps.
3. Exercise: Regular exercise, such as walking or swimming, can help reduce menstrual cramps and improve overall health.
4. Relaxation techniques: Practices like deep breathing, meditation, and yoga can help reduce stress and relieve menstrual cramps.
5. Transcutaneous electrical nerve stimulation (TENS): This therapy involves using a small device that sends electrical impulses to the nerves, which can help reduce pain.
6. Acupuncture: This traditional Chinese medicine practice involves inserting needles into specific points on the body to help reduce pain and improve overall health.