Menorrhagia – Heavy menstrual bleeding

It is a medical term used for prolonged or heavy menstrual bleeding. If you are using more than one sanitary pad or tampon every hour for more than 2 consecutive hours, and if the bleeding continues even after 1 week, it should be evaluated further to find out the cause.

Total menstrual blood loss is between 35-80ml, if the blood loss is more than 80 ml it is termed as menorrhagia.

There are several causes for heavy menstrual bleeding and some among them are:

  1. Hormonal imbalance is the most common cause among all.
  2. 40-60% of those who complain of excessive bleeding have no pathology and this is called dysfunctional uterine bleeding.
  3. 20% of cases are associated with anovulatory cycles and these are most common at the extremes of reproductive life.
  4. Fibroids, Endometrial polyps, Adenomyosis, Endometritis, Endometrial hyperplasia, Pelvic inflammatory disease, Carcinoma, especially endometrial carcinoma in women aged over 40; this usually presents with postmenopausal bleeding, but 20-25% of cases present with abnormalities of the menstrual cycle.
  5. If you have a blood clotting disorder, which means if your body is unable to clot the blood, there will be more bleeding.
  6. Certain medications like anticoagulants,estrogen or progestin pills, can cause more bleeding.

Symptoms to be referred:

  1. Irregular bleeding
  2. Increased blood loss other than normal.
  3. Intermenstrual bleeding
  4. Post coital bleeding(bleeding after intercourse)
  5. Pain during intercourse
  6. Pelvic pain
  7. Pre menstrual pain


First we need to find the cause of the heavy menstruation, and treat accordingly. Treating anemia and abdominal pain is also challenging. The main aims of treatment are to improve symptoms and also quality of life. Treatment is always based on the cause, if hormonal imbalance is the cause, they should be replaced by oral contraceptive pills. If there is iron deficiency anemia, correcting it by giving iron supplements is the best treatment. Surgery is the main option for uterine conditions like fibroids, tumor etc. If even after the treatment the symptoms persists and there is trouble in leading the normal life, hysterectomy is the option.



Dr. Y. Alekhya


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