Heavy menstrual bleeding

Overview

Heavy menstrual bleeding, formerly known as menorrhagia, is a common issue among women, though not all cases of heavy bleeding are severe enough to be classified as such. It’s considered heavy if it extends beyond seven days or involves losing more blood than usual during a menstrual cycle. This might involve needing to change your sanitary products every hour for several consecutive hours, or passing large blood clots, sometimes as big as a quarter or larger.

Additionally, some women experience bleeding between periods, or their menstrual bleeding may occur earlier or later than expected, which is referred to as abnormal uterine bleeding or irregular menstrual bleeding.

Heavy menstrual bleeding can significantly impact daily activities due to the intense flow and cramping. If your period is a source of dread due to these symptoms, it’s important to consult a doctor. There are various treatments available that can provide relief.

Symptoms

Heavy menstrual bleeding symptoms include:

• Period lasting longer than 7 days
• Passing blood clots that are at least 25 mm in size. The blood can seem rust-colored, pink, brown, or red
• Using one or more tampons or sanitary pads every hour for a few hours straight
• Requiring two sanitary pads in order to regulate the menstrual flow
• Symptoms of anemia include fatigue, exhaustion, and shortness of breath
• Waking late at night to replace tampons or sanitary pads
• Losing over 80 milliliters of blood instead of the usual 35–40 milliliters during the menstrual cycle
• Symptoms of pica disorder, such as pale skin, hair loss, and an inclination to eat anything other than food—such as paper, hair, or dirt

Women who encounter exceptionally heavy vaginal bleeding, saturating at least one pad or tampon per hour for more than two consecutive hours, bleeding between periods, or irregular vaginal bleeding, should promptly seek guidance from a healthcare provider. Any vaginal bleeding post-menopause necessitates immediate medical attention. These indicators may suggest underlying health issues that demand assessment and suitable medical intervention.

Causes

In some instances, the exact cause of heavy menstrual bleeding remains unidentified. However, several conditions can lead to this issue, including:

• Hormonal imbalance:  In a typical menstrual cycle, the hormones estrogen and progesterone regulate the buildup of the uterus’s lining, known as the endometrium, which is shed during menstruation. However, when hormonal imbalances occur, the endometrium can thicken excessively, leading to heavy menstrual bleeding or unexpected bleeding between periods. Several conditions can disrupt hormonal balance, including obesity, insulin resistance, thyroid issues, and polycystic ovary syndrome (PCOS).
• Issues related to the ovaries: An imbalance in hormones can lead to heavy menstrual bleeding or unexpected bleeding between periods. This occurs when the body fails to produce the hormone progesterone as it normally does during a menstrual cycle. This is often a result of a condition known as anovulation, in which an egg is not released by the ovaries during a menstrual cycle.
• Uterine fibroids: Prolonged or more intense bleeding during menstruation might be caused by uterine fibroids.  These tumors appear in women who are fertile. Since they are benign, cancer is not present in them.
• Polyps: These growths, often not malignant, may be responsible for bleeding between periods and can lead to spotting or bleeding after menopause. These tiny growths on the uterine lining can result in prolonged or heavy menstrual bleeding.
• Adenomyosis: This condition can lead to painful periods, heavy or prolonged menstrual bleeding with clots, and abdominal/pelvic pain. Adenomyosis occurs when tissue similar to the uterus lining grows into the muscle wall, making the uterus thick and larger than usual, sometimes doubling, or tripling in size.
• Intrauterine device (IUD): Progestin-containing IUDs may lessen heavy menstrual bleeding. One well-known negative effect of using a hormone-free IUD for birth control is heavy menstrual bleeding.
• Pregnancy problems: Heavy bleeding in pregnancy can be caused by the placenta being in an unusual position, such as covering the uterus opening, a condition known as placenta previa. In some cases, a significant and delayed period might signal a miscarriage.
• Cancer: Cervical cancer risk is increased in women with a history of abnormal Pap tests. Unexpected or severe menstrual flow, as well as abnormal uterine bleeding, might be symptoms of cervical or uterine cancer. Both before and after menopause, these tumors can occur.
• Family history of bleeding disorders: Conditions such as von Willebrand’s disease, a disorder that causes improper blood clotting can lead to heavy menstrual bleeding.
• Medications: Blood clot prevention medications like warfarin, enoxaparin, apixaban, and rivaroxaban can contribute to heavy menstrual bleeding. Hormonal medications like birth control pills containing estrogen and progestin, which usually reduce menstrual bleeding, may occasionally lead to unexpected bleeding between periods.
• Other medical issues: Liver, kidney, and thyroid disease are among the various medical conditions that may cause heavy menstrual bleeding.

Risk factors

The release of an egg triggers the body to produce progesterone, a hormone crucial for maintaining regular menstrual cycles. Insufficient progesterone due to the absence of egg release can lead to heavy or unexpected bleeding between periods.
Several risk factors may contribute to heavy menstrual bleeding, such as:

• Age: In adolescents, irregular or heavy menstrual bleeding commonly occurs when an egg is not released during a monthly cycle, especially within the first year after their first period.
• Medical conditions: Various other factors, including uterine cancer, bleeding disorders, medication side effects, and liver or kidney disease, can cause significant menstrual bleeding. For older women in their reproductive years, issues with the uterus, such as fibroids, polyps, and adenomyosis, often contribute to heavy menstrual bleeding.