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Menorrhagia is a condition characterised by abnormally heavy or extended menstrual bleeding.

Symptoms of Menorrhagia

The most common symptoms of menorrhagia are:

  • Menstrual flow that soaks one or more pads per hour for several consecutive hours
  • The need to use double sanitary protection to control the flow of blood
  • Need to change your pad frequently during the night
  • Menstrual period that lasts longer than seven days
  • Menstrual flow that includes large blood clots
  • Affect the daily routine activities due to heavy menstrual flow
  • Fatigue, weakness or shortness of breath (symptoms of anaemia)

Causes of Menorrhagia

The cause of menorrhagia is not known in some cases. However, several conditions that may cause menorrhagia include hormonal imbalance, dysfunction of the ovaries, uterine fibroids (non-cancerous tumours of the uterus), uterine polyps, adenomyosis (where endometrial glands are found in the muscular wall of the uterus), intrauterine devices (IUDs), endometrial hyperplasia, cancer, inherited blood disorders, certain medications (anti-inflammatory medications and anticoagulants), and other medical conditions such as pelvic inflammatory disease (PID), thyroid problems, endometriosis, and liver or kidney disease.

Your doctor will do a pelvic examination and may recommend other tests or procedures such as a pelvic ultrasound scan or an endometrial biopsy (pipelle) of the lining of the womb. Your doctor may also recommend an examination called hysteroscopy, which involves placing a tiny tube with a light through your cervix to obtain a direct view of the lining of the womb.

Treatment options will depend on the cause of menorrhagia, the severity of menorrhagia and the overall health of the patient. Some common treatments include:

  • Iron supplements may be started if your iron levels are low.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce menstrual blood flow as well as cramping.
  • Tranexamic Acid (“Cyclokapron”) can reduce the flow of menstrual blood.
  • Oral contraceptives may be given to help reduce bleeding and make menstrual cycles more regular.
  • Oral progesterone may be given to reduce menorrhagia.
  • Mirena is a type of intrauterine device which releases low-dose progestin in the womb that thins the uterine lining and reduces the blood flow.

Surgery may be needed if medication therapy is not successful. The surgical procedures include:

  • Endometrial ablation: It is a procedure that permanently destroys the entire lining of your uterus (endometrium) resulting in little or no menstrual flow.
  • Hysteroscopy, dilation and curettage (HD&C): This procedure involves the use of a hysteroscope, a tiny tube with a light to view your uterine cavity and to remove abnormalities such as a polyp that may be causing heavy menstrual bleeding. The cervix is dilated and the lining of the uterus is sampled for diagnostic purposes.
  • Hysterectomy: It is surgical removal of the uterus and the cervix that leads to the cessation of menstrual periods.

Surgical procedures such as hysterectomy and endometrial ablation affect your ability to become pregnant. Therefore, discuss with your doctor about the treatment options if you plan to get pregnant in the future.

Related Topics

  • Mater Health
  • UroGynaecological Society of Australasia
  • ANZ Vulvovaginal Society