Heavy Menstrual Flow (Menorrhagia)

Normal menstrual flow typically lasts 3-7 days with an average blood loss of 30-40 milliliters (about 2-3 tablespoons). Heavy menstrual bleeding is defined as losing 80 milliliters or more of blood per cycle, or bleeding that lasts longer than 7 days.

This condition can significantly impact daily life, causing women to miss work or school, avoid social activities, and experience anxiety about bleeding through clothing. The excessive blood loss can also lead to iron deficiency anemia, causing fatigue, weakness, and other health problems.

Heavy menstrual bleeding is not just an inconvenience - it's a medical condition that deserves proper evaluation and treatment. Many effective treatments are available, and most women find significant relief once the underlying cause is identified and addressed.

How to Recognize Menorrhagia

• Soaking through protection: Needing to change pads or tampons every 1-2 hours
• Double protection: Using both pads and tampons together
• Night changes: Waking up to change protection during the night
• Large clots: Passing blood clots larger than a quarter
• Extended duration: Bleeding lasting more than 7 days
• Lifestyle impact: Restricting activities due to heavy flow
• Flooding: Sudden gushes of blood that soak through protection

Associated Symptoms

• Fatigue: Extreme tiredness from blood loss
• Shortness of breath: Due to anemia
• Pale skin: Sign of iron deficiency
• Dizziness: Especially when standing up
• Rapid heartbeat: Heart working harder due to anemia
• Severe cramping: Intense menstrual pain
• Bloating: Abdominal swelling and discomfort
• Headaches: Related to blood loss

Impact on Daily Life

• Missing work or school
• Avoiding social activities
• Fear of bleeding through clothes
• Sleep disruption
• Difficulty exercising
• Emotional stress and anxiety
• Relationship strain
• Financial burden from products

Hormonal Imbalances

• Anovulation: Cycles without ovulation
• Polycystic ovary syndrome (PCOS): Hormonal disorder affecting ovaries
• Thyroid disorders: Both hyper and hypothyroidism
• Perimenopause: Hormonal fluctuations before menopause
• Obesity: Excess estrogen from fat tissue

Structural Abnormalities

• Uterine fibroids: Benign tumors in the uterus
• Polyps: Small growths on uterine lining
• Adenomyosis: Endometrial tissue in uterine muscle
• Endometrial hyperplasia: Thickened uterine lining

Medical Conditions

• Blood clotting disorders: Von Willebrand disease, platelet disorders
• Liver disease: Affects clotting factors
• Kidney disease: Can affect bleeding
• Pelvic inflammatory disease: Infection of reproductive organs
• Endometriosis: Endometrial tissue outside uterus
• Cancer: Uterine, cervical, or ovarian cancer (rare)

Medications and Devices

• IUDs: Especially copper IUDs
• Blood thinners: Anticoagulant medications
• Anti-inflammatory drugs: Can increase bleeding
• Hormonal medications: When starting or stopping
• Chemotherapy: Cancer treatment side effects

Other Factors

• First periods: After menarche
• After pregnancy: First periods postpartum
• Miscarriage: Can cause heavy bleeding
• Ectopic pregnancy: Medical emergency
• Stress: Can affect hormonal balance

Medical History

Your doctor will ask about:

• Menstrual cycle patterns and flow
• Number of pads/tampons used
• Presence and size of clots
• Impact on daily activities
• Associated symptoms
• Sexual history
• Pregnancy history
• Family history of bleeding disorders
• Current medications

Physical Examination

• Pelvic exam: Check for abnormalities
• Bimanual exam: Feel uterus and ovaries
• Speculum exam: Visualize cervix
• Abdominal exam: Check for masses or tenderness

Laboratory Tests

• Complete blood count: Check for anemia
• Iron studies: Ferritin, iron levels
• Thyroid function: TSH, T3, T4
• Coagulation studies: PT, PTT, platelet count
• Pregnancy test: Rule out pregnancy
• Hormone levels: FSH, LH, estrogen, progesterone
• Von Willebrand panel: If bleeding disorder suspected

Imaging Studies

• Transvaginal ultrasound: Visualize uterus and ovaries
• Sonohysterography: Saline infusion ultrasound
• MRI: Detailed imaging for complex cases
• Hysteroscopy: Direct visualization of uterine cavity

Other Procedures

• Endometrial biopsy: Sample uterine lining
• D&C: Dilation and curettage for diagnosis/treatment
• Pap smear: Screen for cervical abnormalities

Practical Tips

• Track your cycle: Use apps or calendars to monitor patterns
• Use appropriate products: Super absorbent pads, menstrual cups, or period underwear
• Plan ahead: Keep extra supplies at work, in car, and bag
• Wear dark clothing: During heavy days to minimize visibility of leaks
• Use waterproof mattress protectors: For overnight protection
• Set alarms: Reminders to change protection
• Stay hydrated: Replace fluid loss
• Rest when needed: Don't overexert during heavy days

Diet and Nutrition

• Iron-rich foods: Red meat, spinach, lentils, fortified cereals
• Vitamin C: Helps iron absorption (citrus, tomatoes, peppers)
• B vitamins: Support blood cell production
• Avoid alcohol: Can worsen bleeding
• Limit caffeine: May increase cramping
• Anti-inflammatory foods: Omega-3 fatty acids, berries

When to Change Treatment

Consider discussing alternative treatments if:

• Current treatment isn't effective after 3-6 months
• Side effects are intolerable
• Your needs or preferences change
• You develop new symptoms
• You're planning pregnancy

Iron Deficiency Anemia

• Most common complication
• Causes fatigue and weakness
• Can affect heart function
• Impairs cognitive function
• Reduces quality of life
• Requires iron supplementation

Quality of Life Impact

• Social isolation
• Work absenteeism
• Depression and anxiety
• Sexual dysfunction
• Financial burden
• Relationship stress

Severe Complications (Rare)

• Severe anemia requiring transfusion
• Hypovolemic shock (extreme cases)
• Endometrial cancer (if untreated hyperplasia)
• Infertility (depending on cause)

Schedule a Doctor's Appointment If:

• Periods regularly last more than 7 days
• You need double protection regularly
• Daily activities are restricted by bleeding
• You have symptoms of anemia
• Bleeding between periods occurs
• Menstrual pattern suddenly changes
• You're concerned about your bleeding