Heavy Menstrual Bleeding (Menorrhagia)

Menorrhagia is a medical term for heavy or prolonged menstrual bleeding, or the excessive loss of blood during your period.

Many girls experience heavy bleeding during their periods. However, girls with menorrhagia have blood loss that is so severe it isn’t manageable with regular sanitary pad or tampon use, disrupts daily activities, interrupts sleep, and can lead to anemia, causing tiredness and shortness of breath.

Patients can be seen by Texas Children's experts in Adolescent Medicine and Pediatric and Adolescent Gynecology.

Causes & Risk Factors

Possible causes include:

• Imbalance in the hormones that control menstruation – causing the lining of the uterus to thicken more than usual; this excessive lining is then shed in the form of heavy menstrual bleeding
• Dysfunction of the ovaries
• Noncancerous growths in the uterus – including fibroids and polyps
• Adenomyosis – when tissue that normally lines the uterus moves into the walls of the uterus
• Intrauterine devices (IUDs)
• Pregnancy complications
• Uterine, ovarian or cervical cancer
• Inherited bleeding disorders – such as von Willebrand's disease, in which your blood doesn’t clot
• Other medical conditions – including pelvic inflammatory disease (PID), thyroid problems, endometriosis, and liver or kidney disease
• Certain medications
• Recently started menstruating (adolescent girls within the first year and a half of their first period)

In some cases, the cause of menorrhagia is unknown. 

Symptoms & Types

Symptoms may include:

• Bleeding that is so heavy it soaks through a pad or tampon every hour for several hours in a row 
• Bleeding that requires the use of a pad and tampon at the same time 
• Nighttime bleeding that requires you to get up and change your pad and/or tampon 
• Bleeding for more than 7 days 
• Passing large blood clots  
• Restricting daily activities due to heavy menstrual flow 
• Tiredness or fatigue
• Shortness of breath

Diagnosis & Tests

Diagnosis starts with a thorough medical history and physical exam, including a pelvic exam.

Your doctor may ask you to keep a record of your period, including when you started and stopped bleeding each month, how heavy the flow was, the number of pads and tampons used, and if they are soaked.

Additional testing may include:

• Blood tests – to check for anemia and other abnormalities
• Urinalysis
• Pap test – to check for infection, inflammation or precancerous changes
• Biopsy – a tiny tissue sample taken from the lining of your uterus is examined under a microscope 
• Imaging tests – including an ultrasound or sonohysterogram to create images of your internal organs and look for abnormalities
• Hysteroscopy – a small, lighted telescope (hysteroscope) is inserted through your vagina and cervix to examine inside the uterus  
• Dilation and curettage (D&C) – a surgical procedure in which a tissue sample is collected from the lining of your uterus and examined in the laboratory

Treatment & Care

Treatment depends on the individual patient, her symptoms and the cause of the heavy bleeding. Treatment strategies include:

• Medications – including over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen or naproxen to reduce blood loss and alleviate pain, and iron supplements for anemia
• Hormone therapies – to help correct hormonal imbalances and control or regulate periods, including oral contraceptive pills, oral progesterone or the hormonal IUD (Mirena) 
• Surgery – to remove the lining of your uterus, uterine growths, or the entire uterus; procedures include dilation and curettage (D&C), operative hysteroscopy, endometrial ablation or resection, or a hysterectomy