Menorrhagia is excessive and/or prolonged menstrual bleeding at regular intervals. Although about 30% of women have heavy periods, only 10% of women have menorrhagia. On average, menstrual flow occurs every 28 days and lasts for five days. Four tablespoons to one cup (60 to 250 milliliters) of blood is lost during this time.
In some cases the cause of menorrhagia is unknown. However, many conditions have been known to be associated with menorrhagia. These include:
- Menstrual cycle hormone dysfunction (imbalance)
- Cervical or endometrial polyps
- Uterine fibroids]]>
- Infection (pelvic infections)
- Blood-clotting disorders
- Anticoagulant medications (blood thinners)
- Anti-inflammatory medications (large amounts over a long period of time)
- Liver, kidney, or thyroid disease
- Problems with an intrauterine device (IUD)
- ]]>Ectopic pregnancy]]>
- ]]>Ovarian cysts]]>
- Chronic medical conditions
- Cancer of the ]]>uterus]]> or ]]>cervix]]> (rare)
- Vaginal injury from trauma or sexual abuse
- Complications from pregnancy, such as ]]>miscarriage]]>
A risk factor is something that increases your chance of getting a disease or condition. People at greatest risk for menorrhagia include:
Symptoms of menorrhagia include:
- Menstrual bleeding lasting more than seven days
- Unusually heavy bleeding (soaking through a sanitary napkin or tampon every hour)
- Menstrual flow requiring change of sanitary protection during the night
- Menstrual flow including large clots
- Menstrual flow interfering with lifestyle
- Fatigue and/or shortness of breath (symptoms of anemia]]> )
Your healthcare provider will ask about your symptoms and medical history. A physical examination including pelvic exam will be done as part of the evaluation. Tests may include:
- Pap test]]>
- Blood tests
- Pregnancy test
- ]]>Ultrasound]]> —a test that uses sound waves to examine your reproductive organs (uterus and ovaries)
- ]]>Endometrial biopsy]]> —removal of a sample of endometrial tissue to look for changes in the lining of the uterus
- ]]>Dilation and curettage]]> (D&C)—scraping of the inner lining of the uterus
- Hysteroscopy—examination of the cervix and fallopian tubes using a telescope-like viewing device
Treatment of menorrhagia will depend on the underlying cause. Women who experience persistent excessive bleeding should discuss with their healthcare provider whether to take iron supplements to prevent anemia.
If there is no medical disorder causing your menorrhagia, your doctor may prescribe the following:
These may include:
- Hormone therapy (estrogen and/or progestogen hormones by mouth, skin application, vaginal application, or injection)
- An IUD that releases a progestogenic drug (Mirena)
- Nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and mefenamic acid (Ponstel, Ponstan)
Procedures may include:
- Dilation and curettage (D&C)
- Operative hysteroscopy—A long, thin instrument is inserted into the uterus that can aid in removal of a polyp or fibroid.
- Endometrial ablation or resection—The surgical removal of the lining of the uterus using heat, microwave, or surgical tools. After this procedure, you will not be able to carry a pregnancy.
- Hysterectomy]]> —The surgical removal of the uterus. After this procedure, you will not be able to carry a pregnancy. If the ovaries are also removed, early menopause will follow.
Your age, overall health, and medical history should be considered when choosing treatment. Discuss with your doctor your plans for having children.
The American College of Obstetricians and Gynecologists
The National Women’s Health Information Center
The Canadian Women's Health Network
The Society of Obstetricians and Gynaecologists of Canada
Harvard Guide to Women’s Health . Harvard University Press; 1996.
Mayo Foundation for Medical Education and Research website. Available at: http://www.mayo.edu/ . Accessed October 13, 2005.
US National Library of Medicine, National Institutes of Health website. Available at: http://www.nlm.nih.gov/ . Accessed October 13, 2005.
University of Utah Health Sciences Center. Available at:
Accessed October 13, 2005.
Last reviewed November 2008 by ]]>Jeff Andrews, MD, FRCSC, FACOG]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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