Causes of heavy menstrual bleeding (menorrhagia)

Heavy menstrual bleeding or menorrhagia can happen due to several medical issues, including fibroids and uterine polyps,menopause, and other factors.

Chronic or heavy menstrual bleeding can cause complications like iron deficiency anemia. The good news is that heavy periods or menorrhagia can be treated with meds, birth control, or surgery.

This article will cover the symptoms of heavy menstrual bleeding, causes, normal versus heavy period lengths, and how to treat heavy bleeding.

Symptoms of heavy menstrual bleeding (menorrhagia)

A typical period lasts 4 to 5 days and involves about 2 to 3 tablespoons of menstrual blood. People with heavy bleeding may lose twice that amount each month.

There are some signs and symptoms that show a woman is losing too much blood during her period. She should see a healthcare provider if these appear. These include:

• Bleeding for 7 days or more.

• Wearing more than one pad at a time to control the bleeding.

• Needing to change the pad every hour for several hours.

• Passing relatively large blood clots.

Reasons for heavy menstrual bleeding (menorrhagia)

There are many causes for heavy periods, including non-cancerous growths like fibroids, or cancers like uterine or cervical cancer. Hormone changes and blood clotting disorders can also cause heavy bleeding.

Other less common causes of heavy menstrual bleeding include endometritis and having an IUD, which can cause excessive bleeding during the first year of use.

But the causes of heavy menstrual bleeding don’t end there. So if you have this problem, it’s important to see a healthcare provider for proper diagnosis and evaluation.

Here are some other reasons your healthcare provider might mention for heavy menstrual bleeding:

• Ovulation problems

Irregular or weak ovulation during teenage years or before menopause can thicken the uterine lining and cause heavy periods. Birth control pills can usually help regulate bleeding in teens, and hormone therapy can help during menopause.

Besides normal hormone changes in puberty or menopause, ovulation problems can also be caused by:

• Thyroid gland underperformance.
• Polycystic Ovary Syndrome.
• Premature ovarian failure.

Getting the right treatment for the root problem is important because it can help restore regular ovulation and bring periods back to normal.

• Uterine fibroids

Uterine fibroids are growths from the muscle cells of the uterus and usually affect women aged 30 to 49. Hormonal birth control, like the pill, can help reduce heavy menstrual bleeding caused by fibroids.

If a woman's symptoms aren’t bothersome or severe, treatment for fibroids might not be needed. Just watching and waiting can be enough since fibroids often shrink on their own after menopause.

Treatments for uterine fibroids include:-

• Intrauterine devices that release progestin.
• Gonadotropin-releasing hormone agonists.
• Endometrial ablation.
• Fibroid tumor removal.
• Uterine artery embolization.
• Hysterectomy with or without ovaries.

• Uterine polyps

Uterine polyps are usually non-cancerous growths that look like grapes and stick out from the uterine lining. They can develop before or after menopause. The exact cause of uterine polyps isn’t really clear.

• Adenomyosis

Adenomyosis happens when uterine lining cells grow into the muscle wall of the uterus. This makes the uterus swell and causes painful heavy bleeding. Hormonal birth control can help manage it, but the only final treatment is removing the uterus.

• Pelvic Inflammatory Disease

PID often happens from untreated sexually transmitted infections. It can sometimes happen after childbirth, miscarriage, or other gynecological procedures.

In this disease, one or more female reproductive parts can get infected, like the uterus, fallopian tubes, and cervix. The recommended treatment for PID is antibiotics.

• Cervical or Endometrial Cancer

Cervical cancer can spread to other parts of the body. There are a few different treatment options for it, including:

• Surgery.
• Chemotherapy.
• Radiation therapy.

Endometrial cancer happens when abnormal cells grow in the lining of the uterus and can spread to the uterus or other body parts. It’s usually diagnosed around the mid-sixties.

The usual treatment for endometrial cancer is removing the uterus. This might be followed by chemotherapy and radiation.

• Bleeding disorders

There are many types of bleeding disorders but the most common in women is Von Willebrand Disease (VWD). Treatments may include releasing stored clotting factors in the blood, or in severe cases, replacing the clotting factor through IV, or using prescribed nasal spray.

Some other bleeding disorders cause heavy or prolonged menstrual bleeding, including:-

• Having a low platelet count.
• Taking blood thinners like aspirin.

• Pregnancy complications

Early pregnancy complications can cause heavy bleeding similar to a period. Common complications include:

• Ectopic pregnancy.
• Miscarriage.

• Medications

Some medications can cause heavier periods or heavy bleeding. These include:

• Blood thinners.
• Antidepressants.
• Antipsychotics.
• Corticosteroids.
• Some medicinal herbs.
• Intrauterine contraceptive devices.
• Hormone replacement therapy.

Seeking medical advice

It's important to get a proper diagnosis to know the main causes of heavy or increased menstrual bleeding. You can do some simple personal steps that might help the doctor diagnose it, For example:-

• Recording your menstrual cycle pattern in the last few months.

• Tracking how many days the bleeding lasts each month.

• Knowing how many pads are needed per cycle.

• Writing down all medications taken, especially those without a prescription like supplements and vitamins.

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