Heavy menstrual bleeding (menorrhagia)

Menorrhagia is the medical name for very heavy menstrual bleeding (soaking through a sanitary pad or tampon every hour for more than a few hours) that lasts longer than seven days. It is a common form of abnormal uterine bleeding. 

Abnormal uterine bleeding affects an estimated 30% of women at some point during their lives. Hormonal changes are often the cause in teenagers during the 1 to 1 ½ years following their first period, as well as in women in their 40s and 50s who are approaching menopause. In general, menorrhagia is more common among older women than among younger women. One study found that nearly 40% of women between the ages of 45 and 60 experienced abnormally heavy periods.

Causes
Besides hormonal changes, other causes of abnormal bleeding are fibroids, ovarian cysts, uterine or cervical polyps, and overgrowth of the uterine lining cells, called "hyperplasia."  All of these can be easily and effectively treated.  Very rarely, abnormal uterine bleeding signals precancer or cancer of the uterus.   

Up to 15% of women who have menorrhagia may have an undiagnosed bleeding disorder called von Willebrand’s disease, an inherited condition in which the blood lacks certain factors needed for proper clotting. Von Willebrand’s disease may be likened to a very mild form of hemophilia and must be treated with the appropriate clotting factors. It is important to get a proper diagnosis of the cause of abnormal bleeding, because the treatments for menorrhagia will not work if the true cause is a bleeding disorder.

Treatment Options
Abnormal uterine bleeding may be treated with hormones, medications, or minimally invasive surgical procedures.

In younger women, treatment with hormones almost always solves the problem. However, if bleeding persists after medical therapy has been tried, certain tests can be used to determine the cause. These include hysteroscopy, D&C,  endometrial biopsy,  sonogram and  saline-infusion sonogram.

The appropriate treatment is determined by the underlying cause of the bleeding. If abnormal bleeding is due to fibroids, resectoscopic myomectomy may be appropriate. If it is due to polyps or hyperplasia, a D&C may correct the problem. In some women, abnormal bleeding may persist even after hormonal treatment, medical therapy or a D&C. Sometimes this is due to changes in the uterine muscle wall or the uterine lining. For those who do not wish to have children and for whom the abnormal bleeding is severe enough to cause anemia, a technique called endometrial ablation may be the right choice.

Hysterectomy should only be used as a last resort, after other approaches have failed, or when appropriate to eradicate uterine cancer.

It is important to discuss all treatment options with your doctor.

References 

1. American Society for Reproductive Medicine. Abnormal Uterine Bleeding: A Guide for Patients. Patient Information Series 1996. www.asrm.org/Patients/patientbooklets/abnormalbleeding.pdf.
2. Lewin Group, Inc. Prevalence and treatment patterns of pelvic health disorders among U.S. women.
3. Marino JL, et al. Uterine leiomyoma and menstrual cycle characteristics in a population-based cohort study. Hum Reprod. 2004;19(10):2350-55.
4. National Women’s Health Resource Center 2007. www.healthywomen.org.
5. Parker WH. A Gynecologist's Second Opinion. ©2003; A Plume Book; Published by the Penguin Group, New York, NY.

Reviewed:  March 2008.