Menorrhagia is a gynaecological condition characterised by abnormally heavy periods or prolonged menstruation. Although it is very common for females to have heavy menstrual bleeding, most women do not experience enough blood loss in menstruation to be classified as menorrhagia. Females with menorrhagia cannot maintain their usual activities as they experience immense pain and blood loss. If you usually have extremely heavy and prolonged periods, you must talk to your healthcare provider regarding them. You might be recommended to undergo certain investigations, and if diagnosed with menorrhagia, there are many treatment plans available to deal with the condition.

Below are the common signs and symptoms associated with menorrhagia:

  • Changing multiple sanitary pads in one day while having periods
  • You may need to use double sanitary pads to manage the menstrual flow
  • Feeling the need to wake up during the night to change the sanitary pad
  • Menstrual bleeding occurs for more than a week
  • Passage of large blood clots with the menstrual blood
  • Restriction of everyday activities because of heavy menstrual flow
  • Anaemia symptoms include fatigue, tiredness, or shortness of breath

You must look for immediate medical care and attention if you face any of the following:

  • Extremely heavy vaginal bleeding so that it soaks one pad in an hour for more than two hours
  • Irregular vaginal bleeding or bleeding in between periods
  • Post-menopausal vaginal bleeding

The reason for heavy menstrual bleeding is unknown in some cases, but in general, there are a few causes associated with the condition, including:

  • Hormonal imbalance
    A balance between the hormones progesterone and estrogen in a normal menstrual cycle regulates the lining of the uterus -the endometrium, which normally sheds at the time of menstruation. In case of a hormonal imbalance, excess endometrium develops and is eventually shed off in the form of heavy menstrual bleeding. Hormonal imbalance can occur due to several conditions, including obesity, polycystic ovarian syndrome, thyroid disorders, and insulin resistance.
  • Dysfunction of the ovaries
    If the ovaries lose the function to ovulate or produce eggs at the time of a menstrual cycle, the hormone progesterone is not created in the body as it would normally do. This may result in hormonal imbalance and, consequently, menorrhagia.
  • Fibroids in the uterus
    These are benign tumours of the uterus that usually appear in females during their reproductive years. Because of uterine fibroids, a heavier or prolonged menstrual period than normal may be experienced.
  • Polyps
    Uterine polyps are small, benign growths on the uterine lining that result in heavy or prolonged menstrual bleeding.
  • Adenomyosis
    This occurs when the endometrial glands get embedded in the muscles of the uterus, often leading to painful periods and heavy bleeding.
  • Intrauterine device (IUD)
    Menorrhagia is a well-known side effect of a non-hormonal intrauterine device used for birth control. Your doctor will devise plans for alternative management options.
  • Pregnancy complications
    Miscarriage may lead to a single, heavy, late period. Another reason for heavy bleeding in pregnant females includes an abnormally placed placenta, like in the case of the low-lying placenta or placenta previa.
  • Cancer
    Excessive menstrual bleeding can also occur if there is uterine or cervical cancer, especially in post-menopausal women.
  • Inherited bleeding disorders
    Few bleeding disorders like von Willebrand's disease can cause abnormal menstrual bleeding.
  • Medications
    Certain types of medications like anti-inflammatory medications, hormonal medications such as progestins and estrogen, and anticoagulants such as warfarin or enoxaparin can give rise to prolonged or heavy menstrual bleeding.
  • Other medical conditions
    There are several other medical conditions like kidney or liver diseases that are associated with menorrhagia.

Your will be asked a few questions about your medical history and menstrual cycles by the doctor. You must maintain a diary making notes of the days you bled, how much the flow was, and how many sanitary pads you would change in one day. Apart from taking history, a complete physical examination will be done by your doctor, and then he will also recommend some tests:

  • Blood test
    Your blood sample may be evaluated for iron deficiency anaemia and several other conditions, including thyroid disorders or blood clotting disorders.
  • Pap test
    Cells from your cervix are taken in this test and tested for any signs of infection or cancerous changes.
  • Endometrial biopsy
    A sample from the inside of the uterus is collected and sent for histopathological examination.
  • Ultrasound
    During this imaging method, ultrasounds are used to produce images of the ovaries, uterus, and pelvis. Depending on the results of your initial investigation reports, further testing, including the following, may be recommended
  • Sonohysterography
    A fluid is injected into the uterus through a tube during this test. Then ultrasound is done to look for any abnormalities in the lining of the uterus.
  • Hysteroscopy
    During this examination, a thin instrument with a camera is inserted into the uterus through the cervix and vagina, which helps the doctor visualise the inside of the uterus.

A certain diagnosis of menorrhagia can be established only after ruling out other medical conditions, menstrual disorders, or medications that are possible triggers of the condition.

The treatment of menorrhagia depends on several factors, including your general health and medical history, the cause and intensity of the condition, your future childbearing plans, your tolerance for several medications and procedures, and your personal preferences. Apart from medication, certain procedures can be performed to deal with the condition, including dilatation and curettage, uterine artery embolisation, focused ultrasound surgery, myomectomy, endometrial ablation, and hysterectomy.