Heavy menstrual bleeding  

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Description of Heavy menstrual bleeding


Menorrhagia (heavy menstrual bleeding) is defined as excessive and prolonged menstrual bleeding, occurring at regular intervals. Normal menstrual period lasts for 4 to 5 days with 25 to 80 ml of blood loss. Menorrhagia is said to occur when blood loss is greater than 80 ml or if the bleeding lasts for more than 7 days.

It is also commonly known as hypermenorrhea.

Causes and Risk Factors

The cause of menorrhagia is usually not identified. Some of the causes that may be associated with the problem include:

1. Ovarian endocrine disorder or dysfunctional uterine bleeding (DUB)

2. Blood coagulation disorders: Immune thrombocytopenic purpura (ITP), von Willebrand disease

3. Drugs such as anticoagulants

4. Menopause

5. Intrauterine contraceptives devices

6. Uterine fibroids

7. Endometrial infection

8. Endometrial abnormalities, e.g., endometriosis, adenomyosis

9. Endometrial carcinoma (cancer of inner lining of uterus)

10. Excess anxiety, stress, and tension

Signs and Symptoms 

Common symptoms are:

1. Menstrual bleeding for more than 7 days

2. Excessive bleeding that may soak one or more sanitary pads every hour for a number of hours

3. Shortness of breath, tiredness, fatigue during menstrual period

4. Large blood clots during menstrual period


Investigations include:

1. Pelvic and rectal examination (for any abnormality or cause of bleeding)

2. Pelvic ultrasound (to check for any structural abnormality)

3. Pap smear (scrapings of cells from inner lining of cervix are examined microscopically for any cancerous changes)

4. Endometrial biopsy (to rule out atypical hyperplasia or endometrial cancer)

5. Hysteroscopy (endoscopic examination of uterine cavity)

6. Bleeding time and coagulation tests

7. Platelet function studies

8. D&C (dilation and curettage) operation — done to collect scrapings from the inner wall of uterus, which is then examined microscopically for any hormonal abnormality/disorders.


1. In mild cases with less bleeding, no treatment is usually required.

2. All patients with menorrhagia are advised bed rest, to avoid exertion, vigorous exercise, anxiety, and tension.

3. Medications


Prognosis is generally good if the diagnosis and treatment are adequate.