Heavy menstrual bleeding, medically termed as “menorrhagia” is cyclical menstrual bleeding for more than 7 days or more than 80 ml in volume of blood loss. Although heavy menstrual bleeding is a common concern, most women don’t experience blood loss severe enough to be defined as menorrhagia. It is more common in adolescent girls due to having initial cycles without ovulation (anovulation)
In some cases, the cause of heavy menstrual bleeding is unknown, but a number of conditions may cause menorrhagia. Common causes include:
- Hormone imbalance. In a normal menstrual cycle, a balance between the hormones estrogen and progesterone regulates the buildup of the lining of the uterus (endometrium), which is shed during menstruation. If a hormone imbalance occurs, the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding. Conditions that can cause hormone imbalances include polycystic ovary syndrome (PCOS), obesity, insulin resistance, thyroid problems and some drugs.
- Ovarian dysfunction in cases where the egg isn’t released (anovulation), the hormone progesterone won’t be enough, as it would during a normal menstrual cycle. This causes excessive bleeding
- Uterine fibroids. These are non-cancerous (benign) tumors of the originating from the uterine muscle. They appear commonly in women who haven’t or delayed being pregnant during reproductive age. Uterine fibroids may cause heavier than normal or prolonged menstrual bleeding.
- Polyps – these are small, benign growths on the lining of the uterus (uterine polyps)
- This condition occurs when glands from the endometrium become embedded in the uterine muscle, often causing heavy bleeding and painful periods.
- Intrauterine device (IUD) inserted for birth control. However, hormone containing IUDs can reduce bleeding after 6 months of consistent use.
- Cancers of the uterus, and ovary.
- Inherited bleeding disorders. Some bleeding disorders — such as von Willebrand’s disease, a condition in which an important blood-clotting factor is deficient or impaired — can cause abnormal menstrual bleeding and hemophilia
- Medications including anti-inflammatory medications, and anticoagulants such as warfarin and heparin
- Other medical conditions including liver or kidney disease may be associated with menorrhagia.
- Pelvic endometriosis – a condition where tissue similar to that lining the uterus is found outside the uterine cavity, in this case in within the pelvis
- Infections like tuberculosis of the uterine lining (tubercular endometriosis)
- Retroverted uterus, that is abnormal curving of the uterus backwards
It’s very important for a woman to see a doctor who will look for the cause of heavy menses and treat it accordingly.