Menorrhagia is a medical term that refers to abnormally heavy or prolonged menstrual bleeding.

It is one of the most common gynecological complaints, affecting more than 10 million people in the United States each year. Menorrhagia can affect anyone who menstruates and has not reached menopause, regardless of gender.

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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Average blood loss during menstruation is about 2–3 tablespoons, equating to 30–45 milliliters, over 4–5 days. However, a person with menorrhagia may experience bleeding that lasts longer than 7 days or heavy bleeding that causes them to soak through one or more tampons or pads every hour for several hours in a row.

A person with menorrhagia may need to wear more than one pad at a time or change their pad or tampon during the night.

Heavy menstrual bleeding is very common, and about one-third of females seek treatment for it. However, it can still interrupt daily life and, in some cases, signify a more serious health problem.

Untreated heavy bleeding can cause anemia, a condition that occurs when the blood does not carry enough oxygen to the rest of the body. The symptoms can include fatigue, weakness, and chest pain.

Learn more about the symptoms of anemia.

Abnormally heavy or prolonged menstrual bleeding can have many causes. Possible causes of menorrhagia fall into three categories: uterine-related problems, hormone-related problems, and other illnesses or disorders.

The possible causes include:

  • Uterine fibroids: These noncancerous tumors grow either inside or outside the uterine wall. They can cause heavy bleeding or painful periods.
  • Uterine polyps: Polyps are overgrowths of endometrial tissue, which is the type of tissue that lines the inside of the uterus.
  • Irregular ovulation: If hormonal disruptions cause irregular ovulation, the lining of the uterus can build up and become too thick. When this lining eventually sheds during menstruation, heavy bleeding can occur. This is common during puberty and perimenopause. It can sometimes occur due to weight loss or stress or as a symptom of certain medical conditions, including polycystic ovary syndrome (PCOS) and hypothyroidism.
  • Adenomyosis: In people with this condition, tissue from the lining of the uterus becomes embedded in the muscle of the uterus. It can cause painful and heavy menstrual bleeding.
  • Nonhormonal intrauterine device (IUD): This type of birth control device sits in the uterus and can cause heavy bleeding.
  • Pelvic inflammatory disease (PID): This infection of the reproductive organs often results from untreated sexually transmitted diseases.
  • Pregnancy-related complications: Pregnancy-related problems, such as pregnancy loss or an ectopic pregnancy, can cause abnormal bleeding.
  • Cancer: Uterine, cervical, and ovarian cancers affect the reproductive system and cause heavy bleeding.
  • Inherited bleeding disorders: Examples include Von Willebrand’s disease and platelet function disorders.
  • Medications: Certain anti-inflammatory and anticoagulant drugs can lead to heavy bleeding.

Other health conditions that can cause menorrhagia include thyroid disorders, endometriosis, and liver or kidney disease.

The symptoms of menorrhagia can include:

  • a heavy menstrual flow that soaks through one or more sanitary pads or tampons every hour for several consecutive hours
  • heavy bleeding that requires a person to use more than one period product at a time
  • the need to change pads or tampons in the middle of the night
  • menstrual flow or bleeding lasting more than a week
  • the passage of blood clots that are the size of a quarter or larger
  • symptoms of anemia, including fatigue and shortness of breath
  • constant lower abdominal and pelvic pain
  • the inability to perform regular daily activities because of bleeding

If bleeding interferes with daily life or emotional well-being, it is advisable to seek help from a doctor.

The treatment options for menorrhagia will depend on the individual case and the underlying cause of bleeding.

The doctor will consider the person’s age, general health, and medical history, as well as their preferences and needs regarding menstruation. For example, while some people may want a treatment that stops menstruation completely, others may prefer to keep having a period.

Drug therapy options may include:

  • iron supplements to treat anemia
  • birth control pills to make periods more regular, reduce bleeding, or stop bleeding completely
  • tranexamic acid (Lysteda), a prescription medication that a person takes each month at the time of bleeding to help reduce blood loss
  • hormone therapy with drugs containing estrogen, progesterone, or both to reduce the amount of bleeding
  • planting a hormonal IUD in the lining of the uterus, which can help reduce bleeding and cramping
  • medications that help treat the underlying cause of heavy menstrual bleeding

Nonsteroidal anti-inflammatories (NSAIDs), such as ibuprofen, can treat dysmenorrhea or painful menstrual cramps. However, some NSAIDs, such as aspirin, can increase the risk of bleeding and may not be suitable for people with heavy periods.

Surgical interventions

Several surgical procedures are available to relieve the symptoms of menorrhagia. A doctor will determine which, if any, surgical intervention is most appropriate. They will consider the cause and extent of the bleeding, the age and health of the person, and their personal preference and expectations.

The options may include:

  • Dilation and curettage: Dilation and curettage is a surgical procedure in which a surgeon removes a layer of the uterine lining to reduce menstrual bleeding.
  • Uterine artery embolization: This procedure treats fibroids by blocking the arteries that supply them with blood.
  • Operative hysteroscopy: A surgeon will insert a small camera into the uterus to evaluate the lining. If necessary, they will remove any polyps and the uterine lining to reduce heavy menstrual flow.
  • Focused ultrasound ablation: This procedure uses ultrasonic waves to kill fibroid tissue.
  • Myomectomy: This procedure removes uterine fibroids or stops heavy bleeding without removing the uterus.
  • Endometrial ablation: A surgeon will permanently destroy the lining of the uterus to stop or reduce menstrual bleeding.
  • Hysterectomy: This surgical procedure removes the uterus, cervix, and, sometimes, the ovaries. In doing so, it permanently stops menstruation and removes the ability to become pregnant.

If a person’s periods last longer than 7 days or interrupt daily life, they should contact a doctor.

If the doctor suspects menorrhagia, they will ask the person about their symptoms and their medical and menstrual cycle history. They may also carry out a physical examination.

Tests that can help diagnose menorrhagia include:

  • blood tests to check for anemia, thyroid disease, and clotting disorders
  • Pap smear to evaluate for cervical infection, inflammation, and cancer
  • endometrial biopsy to test the lining of the uterus for cellular abnormalities and cancer
  • ultrasound to evaluate the pelvic organs, including the uterus, cervix, and ovaries
  • sonohysterogram, which involves injecting fluid into the uterus and using ultrasound to evaluate for abnormalities
  • hysteroscopy, which involves inserting a camera into the uterus to inspect the lining for abnormalities
  • dilation and curettage, which a doctor may use to detect and treat abnormalities

Keeping a diary of the length and heaviness of menstruation and sharing the information with the doctor may helo with the diagnosis.

In some cases, a person’s symptoms may be due to other types of irregular bleeding. These include:

  • Polymenorrhea: This is menstruation that happens too often.
  • Oligomenorrhea: This term refers to menstrual bleeding that is infrequent or inconsistent.
  • Metrorrhagia: This irregular bleeding happens between cycles and does not appear to be linked to menstruation.
  • Postmenopausal bleeding: This occurs during menopause, meaning that a person experiences it more than a year after their last period.

As these types of bleeding do not have strict criteria for diagnosis, doctors now refer to them less frequently. However, it may still be beneficial for a person to know about different menstrual bleeding patterns.

Learn more about other menstrual conditions.

Anyone experiencing menstrual bleeding that lasts longer than 7 days or requires them to change their pad or tampon every hour for multiple hours in a row should speak with a doctor. The doctor can help diagnose the cause and provide treatment.

Heavy menstrual bleeding can be due to hormone-related causes or medical conditions, including delayed ovulation, cancer, PID, and inherited bleeding disorders.

Sometimes, heavy bleeding is a side effect of medications or results from pregnancy-related complications.

Treatments to reduce abnormally heavy bleeding depend on the underlying cause, but they can include hormonal birth control, hormonal therapy, and drugs that reduce the amount of bleeding. Sometimes, a doctor may recommend a surgical procedure to reduce or stop bleeding if other treatments do not prove effective.