Heavy Menstrual Bleeding

Menstruation is the monthly vaginal bleeding women experience as the uterine lining is shed. Every month, an ovary releases an egg that travels down the fallopian tube to the uterus. If the egg is not fertilized, the egg and lining of the uterus are shed, resulting in menstruation. The average menstrual period lasts from 3 to 5 days, although it can vary from person to person and month to month.

Some women have heavy menstrual bleeding (menorrhagia) on a regular basis. In addition to a heavy flow, the bleeding can last for more than 7 days. Heavy menstrual bleeding can interfere with a woman's daily life, and can cause anemia, an iron deficiency whose symptoms are weakness and fatigue.

Symptoms of Heavy Menstrual Bleeding

In addition to a heavier-than-normal menstrual flow, a woman with menorrhagia may experience the following:

  • Bleeding for more than 1 week
  • Large blood clots in the menstrual flow
  • Constant pain in the lower abdomen
  • Anemia

If a woman with heavy menstrual bleeding develops anemia, she can experience weakness, fatigue and shortness of breath.

Causes of Heavy Menstrual Bleeding

Heavy menstrual bleeding can be caused by various conditions or factors, including the following:

  • Uterine fibroids
  • Polycystic-ovary syndrome
  • Hormonal imbalance
  • Complications from pregnancy
  • Intrauterine device (IUD)
  • Polyps
  • Cancer
  • Certain medications

Heavy menstrual bleeding may also be caused by a platelet disorder or von Willebrand's disease. In some cases, the cause of heavy menstrual bleeding is unknown.

Diagnosis of Heavy Menstrual Bleeding

Heavy menstrual bleeding may be diagnosed through a physical examination, and review of the patient's medical history. Additional diagnostic tests may include the following:

  • Blood tests
  • PAP tests
  • Endometrial biopsy
  • Ultrasound

A hysteroscopy may be performed to view the inside of uterus, and determine whether fibroids, polyps or other problems are causing the heavy bleeding.

Treatment for Heavy Menstrual Bleeding

Treatment for heavy menstrual bleeding varies depending on whether there are any underlying conditions. Iron supplements to treat anemia, and anti-inflammatory medication to reduce the amount of bleeding, are often prescribed. Additional treatments may include the following:

  • Oral contraceptives
  • Hormone supplements
  • IUD removal
  • Tranexamic acid

If conservative methods are unsuccessful, surgery may be necessary. Surgical procedures may include the following:

  • Dilation and curettage
  • Endometrial ablation (destroys uterine lining)
  • Myomectomy (removes uterine fibroids)

In severe cases, a hysterectomy may be recommended.

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