Potential Causes of Heavy Menstrual Bleeding (Menorrhagia)

Menorrhagia is a medical condition in which the menstrual bleeding becomes relatively heavy or prolonged. Although heavy bleeding does not always indicate menorrhagia, heavy and prolonged bleeding is also a common concern among women who are going through the premenopausal stage.

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Abnormal uterine bleeding (AUB) or menorrhagia is a serious condition where your daily life starts getting adversely affected by the cramping and excessive flow of blood. If you start experiencing blood flow that is too severe or any of the symptoms mentioned below, it is better to get yourself examined for any underlying problems.

Symptoms of menorrhagia:

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  • Your daily routine and day to day activities start getting affected due to heavy menstrual flow.
  • You need to use double sanitary protection to control your menstrual flow.
  • Bleeding continues for more than a week.
  • Soaking through one or more sanitary pads or tampons every hour for several consecutive hours.
  • Passing blood clots with menstrual flow for more than one day.
  • You need to wake up to change sanitary protection at night.
  • Symptoms of anemia, such as tiredness, fatigue or shortness of breath.

Causes of heavy menstrual bleeding:

There are several potential causes that may lead to excessive menstrual bleeding. Here, we have listed some of the most common causes for you:

1. Hormonal imbalance– Hormonal imbalance is one of the most common causes of menorrhagia or excessive menstrual bleeding during adolescence. When you ovulate every month, the hormone progesterone is released and if during a menstrual cycle, your ovaries cease to release an egg this creates an imbalance of hormones which often leads to excessive bleeding or menorrhagia.

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2. Uterine fibroids– These are non-cancerous (benign) tumors that may appear in the uterus during the child bearing years especially in your 30s and 40s. The cause of these tumors is not yet known but these tumors are known to be estrogen dependent. There are a number of surgical options available for treating fibroid tumors including myomectomy, endometrial ablation, uterine artery embolization, and uterine balloon therapy, as well as hysterectomy. Nonsurgical option include GnRH agonists, and oral contraceptives are also available. Once a women enters menopause the uterine fibroid tumors shrink and dissolve on their own.

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3. Cervical polyps– Cervical polyps occur in the cervix where it opens to the vagina. Polyps look like small bulbs on a stem and may occur in groups or alone. These may also vary in size and color. Although not all polyps are cancerous, you must get them checked for the signs of cancer and should get them removed.

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4. Pelvic inflammatory disease– Pelvic inflammatory disease is an infection that affects one or more reproductive organs including uterus, fallopian tube and cervix. A female may contract this disease through sexual practice or even following childbirth, abortion, or other gynecological procedures. The best way to get PID treated is through antibiotic therapy.

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5. Cervical cancer- Cervical cancer involves uncontrollable and unlimited growth of cells in the cervix. Though cervical cancer is one of the most uncommon cause of heavy menstrual bleeding but can be one of the potential causes.

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6. Intrauterine devices- One of the most common causes of excessive menstrual bleeding is intrauterine devices used for birth control. If the bleeding persists for a long period of time you might have to get the IUD removed.

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7. Inherited bleeding disorder– Diseases such as Von Willebrand may also be the reason for excessive menstrual bleeding in which an essential blood- coagulation factor is impaired or absent. This may be hereditary or in certain cases acquired and platelets-type.

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8. Adenomyosis- Adenomyosis is a condition in which the inner lining of the womb (the endometrium) breaks through the muscle wall of the womb (the myometrium). This can cause bloating, lower abdominal pressure and menstrual cramps before and during the menses and can also result in heavy bleeding. This condition most commonly occurs in middle aged women after having children.

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9. Medications- Certain medicines and drugs such as those for anti-inflammation and anticoagulants can add up to heavy or abnormal menstrual bleeding.

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The treatment for the following can be determined only after the diagnosis of the potential cause which leads to AUB.