Menorrhagia: Heavy Periods, Causes, Symptoms & Treatment

Menorrhagia is unusually heavy or prolonged menstrual bleeding, which can have a negative impact on daily life, work, studies and general well-being.

What are the symptoms of heavy menstrual bleeding?

Periods last longer than a week;
One or more tampons or pads become saturated within an hour, and this continues for more than 2 hours;
You need to use several sanitary products at the same time;
You have to change sanitary towels or tampons during the night;
Large blood clots are passed;
You experience severe period pain;
Blood loss causes tiredness, weakness or shortness of breath;
Your period interferes with your normal daily activities.

Possible causes of heavy periods

Hormonal imbalances: hormones regulate the menstrual cycle and the intensity of bleeding. Heavy bleeding may be caused by anovulation, thyroid disorders, polycystic ovary syndrome, being overweight or obese.
Benign tumours in the uterus: polyps, fibroids or adenomyosis can also cause heavy bleeding during
Infections: certain infections can cause abnormal bleeding – chlamydia, gonorrhoea, trichomoniasis, chronic endometritis and pelvic inflammatory disease.
Pregnancy complications: miscarriage, ectopic pregnancy, complications following childbirth or a caesarean section;
Medicines and contraceptives: blood-thinning medicines, aspirin, hormone therapy, tamoxifen, certain contraceptives and intrauterine devices (IUDs);
Cancers: uterine cancer, cervical cancer and breast cancer.

Risk factors

Menopause;
Hormonal imbalance;
Polycystic ovary syndrome;
Overweight and obesity.

What are the complications of heavy menstrual bleeding?

If left untreated, heavy menstrual bleeding can lead to: iron-deficiency anaemia, severe tiredness, weakness, shortness of breath and a reduced quality of life. In some cases, heavy bleeding may be a sign of a serious condition, so it is important to identify the cause.

How is menorrhagia diagnosed?

Medical history and gynaecological examination: to diagnose menorrhagia, the doctor will ask about troublesome symptoms and past medical history, and will carry out a gynaecological examination of the abdomen and pelvis;
Laboratory tests: a complete blood count and biochemical blood tests, as well as hormone tests to assess thyroid and adrenal function and rule out other possible causes;
Ultrasound scan: this allows the size and structure of the uterus and ovaries to be assessed and any possible abnormalities, such as fibroids, polyps or adenomyosis, to be identified;
Sonohysterography: a specialised ultrasound scan during which a sterile fluid is injected into the uterine cavity. The examination helps to assess the uterine lining more accurately and detect polyps or other changes within the cavity;
Hysteroscopy: a procedure that allows the doctor to examine and assess changes in the uterine cavity and perform interventions;
Endometrial biopsy: in some cases, a small sample of endometrial tissue is taken. This is examined under a microscope to rule out precancerous changes or endometrial cancer.

What is the treatment for menorrhagia?

Medication

Non-steroidal anti-inflammatory drugs (NSAIDs) – reduce bleeding and period pain;
Hormonal contraception – regulates the menstrual cycle and reduces the intensity of bleeding;
Progesterone preparations – help to correct hormonal imbalances;
Hormonal intrauterine device (IUD) – thins the lining of the womb and significantly reduces menstrual bleeding;
Other hormonal medicines – may be prescribed for fibroids, endometriosis or other gynaecological conditions.

Interventional treatment

Endometrial ablation – a procedure in which part of the endometrium is removed. It may be performed for diagnostic or therapeutic purposes;
Uterine artery embolisation – a minimally invasive procedure that reduces blood flow to uterine fibroids, causing them to shrink;
Myomectomy – a surgical procedure in which uterine fibroids are removed whilst preserving the uterus;
Endometrial ablation – a procedure in which the lining of the uterus is destroyed to reduce or stop menstrual bleeding;
Endometrial resection – a surgical procedure in which the lining of the womb is removed using specialised surgical instruments;
Hysterectomy – a surgical procedure to remove the womb. It is considered a last-resort treatment when other measures are ineffective or serious gynaecological conditions are diagnosed.

What will happen if menorrhagia is left untreated?

Untreated menorrhagia can lead to severe anaemia and significantly impair quality of life. In some cases, heavy bleeding may be a symptom of a more serious condition, so it is important to consult an obstetrician-gynaecologist to determine the cause.