Menorrhagia: Understanding Severe Menstrual Bleeding

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Introduction

Some women experience hefty and prolonged menstrual bleeding, a condition known as menorrhagia. But in daily life, we see that Menstruation is a natural part of every woman’s reproductive life. Severe bleeding is an exception! Periods are manageable, even if occasionally uncomfortable. We met some patients whose menses are more than just a “heavy period”. They interfere with the lady’s daily life, cause anemia, and sometimes point a health problem.

Together, let’s find out the signs of disorder, its common causes, when to see a doctor, and the available treatments. By understanding the condition, women can take charge of their health and seek timely care.

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Signs of Severe Menstrual Bleeding

How do you know if your periods are heavier than normal? These are the typical signs of menorrhagia:

• Needing to change sanitary pads or tampons every 1–2 hours for several hours in a row.
• Passing large blood clots, often bigger than a coin.
• Menstrual bleeding that lasts more than 7 days.
• Needing to use double protection (tampon + pad) to prevent leaks.
• Waking up at night to change pads due to soaking.
• Feeling tired, weak, or dizzy due to iron-deficiency anemia caused by blood loss.

While occasional heavy cycles may happen, persistent symptoms like these should raise concern and prompt a medical consultation.

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Causes of Menorrhagia

Menorrhagia can develop for many reasons, and identifying the underlying cause is key to effective treatment. Below are the most common:

1. Hormonal Imbalance

• Estrogen and progesterone control the menstrual cycle. If ovulation does not occur, the endometrium (uterine lining) may grow excessively, leading to heavy bleeding when it sheds.
• Common in adolescents (early menstrual years) and perimenopausal women.

2. Uterine Conditions

• Fibroids (leiomyomas): Noncancerous growths in the uterus that increase blood flow and pressure inside the womb.
• Polyps: Benign growths on the uterine lining that cause irregular spotting or heavy bleeding.
• Adenomyosis: When endometrial tissue grows into the muscular wall of the uterus, leading to painful, heavy periods.

3. Bleeding Disorders

• Conditions like von Willebrand disease, platelet disorders, or clotting factor deficiencies can cause abnormal bleeding.
• Often suspected in teenagers who present with unusually heavy periods from their first cycle.

4. Endocrine and Systemic Illnesses

• Thyroid disorders (both hypo- and hyperthyroidism) can disturb hormonal balance.
• Liver disease and kidney disease affect blood clotting mechanisms, worsening bleeding.

5. Pregnancy-Related Causes

• Miscarriage, ectopic pregnancy, or retained tissue after delivery or abortion can cause sudden, severe bleeding.

6. Medications and Devices

• Anticoagulants (blood thinners like warfarin, heparin, or DOACs) can prolong bleeding.
• Hormonal therapies with improper dosing.
• Copper intrauterine device (IUD): Can cause heavier periods in some women.

7. Cancer and Precancerous Changes

• Endometrial hyperplasia (thickening of the uterine lining, sometimes precancerous).
• Endometrial cancer or cervical cancer, particularly in women over 40–45 years, may present with abnormal bleeding.

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When to See a Doctor Urgently

Not all heavy periods are dangerous, but certain symptoms require urgent medical care. Seek help if:

• You soak through a pad or tampon every hour for several consecutive hours.
• You feel lightheaded, faint, or short of breath.
• Severe pelvic pain accompanies bleeding.
• You are over 45 and notice sudden heavy or irregular bleeding.
• You pass very large clots frequently.

Ignoring these warning signs can lead to severe anemia, life-threatening blood loss, or missed diagnoses of serious conditions like cancer.

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Treatments for Menorrhagia

Treatment depends on the cause, severity, age, and whether the woman wants to preserve fertility. Options include both medical and surgical approaches.

1. Medications

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Ibuprofen and naproxen reduce bleeding by lowering prostaglandin levels.
• Tranexamic Acid (TXA): An antifibrinolytic medicine taken during periods to reduce blood loss.
• Hormonal Therapy:
  • Combined oral contraceptive pills help regulate cycles.
  • Oral or injectable progesterone balances hormones and reduces flow.
  • Levonorgestrel-releasing intrauterine device (IUD, e.g., Mirena): Highly effective, reducing blood loss by up to 90%.
• Gonadotropin-Releasing Hormone (GnRH) Agonists: Temporarily shrink fibroids or treat adenomyosis, usually before surgery.

2. Treating the Underlying Cause

• Thyroid medication for thyroid disorders.
• Specific therapy for bleeding disorders, such as desmopressin or clotting factor replacement.
• Removal or replacement of the copper IUD if contributing to bleeding.

3. Surgical Treatments

• Dilation and Curettage (D&C): Temporary relief and diagnostic procedure.
• Endometrial Ablation: Destroys uterine lining; suitable for women who no longer wish to conceive.
• Myomectomy: Removes fibroids while preserving the uterus.
• Hysterectomy: Complete removal of the uterus; a permanent solution, usually for women with severe or recurrent menorrhagia who are done with childbearing.

4. Supportive Care

• Iron supplementation (oral or IV) to correct anemia.
• Blood transfusion in severe, acute cases.

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Summary

Menorrhagia, or severe menstrual bleeding, is a common condition that can significantly affect a woman’s quality of life. Signs include prolonged periods, large clots, and needing frequent pad changes. The causes range from hormonal imbalances and fibroids to bleeding disorders, thyroid disease, and rarely cancer.

Treatment options include pain relievers, hormonal therapy, tranexamic acid, intrauterine devices, and surgical procedures depending on the underlying cause and a woman’s reproductive goals. Importantly, women should seek medical help urgently if bleeding is excessively heavy, accompanied by faintness, or if they are over 45 with new symptoms.

By understanding menorrhagia and recognizing when to seek care, women can find effective treatment and prevent complications such as anemia and severe fatigue.

For More Reading:

NICE guideline on heavy menstrual bleeding (NCBI Bookshelf) / Mayo Clinic’s overview of menorrhagia: symptoms, causes, and treatments / ACOG’s FAQ on heavy menstrual bleeding

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