Menorrhagia

Some women have heavier periods than others. However, if menstrual bleeding lasts for longer than 7 days, cannot be controlled by sanitary towels or tampons, or includes large blood clots, it is classed as menorrhagia. In some cases, this condition may be associated with a dragging pain in the lower abdomen. Menstruation may also be irregular. Severe menstrual bleeding may lead to iron-deficiency anaemia, causing light-headedness and tiredness. About 1 in 20 women has menorrhagia regularly. The condition is more common in women approaching the menopause.


What are the causes?

Heavy or prolonged menstrual bleeding can be a symptom of various disorders of the uterus, such as fibroids, uterine polyps, or cancer of the uterus. Menorrhagia is also a well-known side effect of using an intra-uterine contraceptive device (IUD). A single heavy period that is late may be a miscarriage. Menorrhagia may also be caused by a hormonal disorder, such as hypothyroidism. The condition occurs more commonly in women who are overweight.

Sometimes, the cause is not clear. If your periods have always been heavy, there is probably no need for concern. However, you should consult your doctor if the problem affects your lifestyle.

How is it diagnosed?

Your doctor will examine you and may arrange for blood tests to measure your hormone levels and to look for signs of anaemia. Further investigations, such as ultrasound scanning to look for fibroids or polyps in the uterus, may be necessary. You may also have a hysteroscopy, in which a viewing in instrument is passed through the cervix to examine the uterus. A small sample of the endometrium (the lining of the uterus) may be taken for analysis.

What is the treatment?

Treatment depends on the cause, your age, and the severity of the bleeding. Any underlying disorder will be treated. If no cause is found, drugs may initially be given to reduce blood loss. You may want to consider changing your method of contraception if you use an IUD. If you are overweight, losing weight may help.

If initial treatments do not help or if menorrhagia is severe, you may require laser surgery to remove the endometrium or an operation to remove the uterus. These procedures are irreversible and are only offered to women who do not want to have children in the future. Laser removal of the endometrium is a minor procedure, but it carries a small risk that problems will recur if any endometrial tissue remains. A hysterectomy is a major operation but ensures that menorrhagia will not recur.