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Heavy Menstrual Bleeding

Heavy menstrual bleeding or menorrhagia

When the menstrual bleeding lasts more than seven days, it is classified as heavy. Clinically, on an average a lady menstruates about 30-40 ml of blood during the menstrual cycle but in case of heavy bleeding, blood loss may be up to 80 ml.


The cause of heavy menstrual bleeding, in some cases, is unknown. However, a hormone imbalance, dysfunction of the ovaries, uterine fibroids and polyps, adenomyosis – a condition in which the glands from the endometrium embed in the uterine muscles can be the cause. It can also be genetic. Also, the intrauterine device (IUD) used for birth control or a miscarriage can lead to heavy bleeding. But if bleeding occurs at the usual time of menstruation, miscarriage is unlikely to be the cause.

Among other causes, cancer (uterine, ovarian and cervical) can cause excessive menstrual bleeding. A number of other medical conditions, including pelvic inflammatory disease (PID), thyroid problems, endometriosis, and liver or kidney disease, may be associated with heavy bleeding.

Risk factors:

The risk of disease increases due to a hormone imbalance either during menarche or menopause.

Clinical presentation /Signs and symptoms:

If the use of sanitary pads or tampons is frequent, say about one every hour, then it indicates heavy bleeding. The patients with heavy bleeding pass blood clots for more than a day with menstrual flow, which pushes the patient to restrict their daily activities.

Apart from blood discharge, a patient with heavy bleeding feels tired, fatigued or even experience shortness of breath. All these symptoms are specific to anaemia – low haemoglobin in the blood.


Excessive or prolonged menstrual bleeding can lead to other medical conditions, like iron deficiency anaemia, severe pain along with painful menstrual cramps.


A physical examination followed by a few tests, including blood, Pap test, endometrial biopsy and an ultrasound is generally prescribed.


Patients with heavy bleeding, in the first place, are given hormone therapy and drugs to relief them of pelvic pain or menstrual cramps. To improve anaemia iron supplements are prescribed. However, if drugs fail, surgical procedures are carried out to remove cysts and polyps. In few cases, endometrial ablation, a medical procedure is employed to remove (ablate) or destroy the endometrial lining of a uterus. This technique is often used for people who cannot or do not wish to undergo a hysterectomy.