Abnormally Heavy Periods (Menorrhagia)

Medical assistance should be sought after if there is vaginal bleeding that saturates a tampon or pad within an hour consecutively, irregular bleeding during cycles (in between periods), or any bleeding after menopause. If menorrhagia is not treated, serious problems such as severe pain and iron deficiency anemia can occur.

Symptoms of menorrhagia are as follows:

  • Anemia: fatigue, shortness of breath.
  • Bleeding for over a week.
  • Saturation of one or several pads/tampons within an hour consecutively.
  • Preventing daily activities due to substantial menstrual flow.
  • Producing blood clots within menstrual flow for several days.
  • Requiring multiple sanitary protection methods to control menstrual flow (tampon + pad, etcetera).
  • Waking during the night to change sanitary protection.

Causes of heavy menstrual bleeding remains ambiguous, but there are a few conditions believed to cause menorrhagia:

  • Hormone imbalance
  • Ovary malfunction
  • Uterine fibroids
  • Polyps
  • Adenomyosis
  • Intrauterine device
  • Pregnancy problems
  • Inherited disorders of bleeding
  • Particular medications
  • Pelvic inflammatory disease
  • Thyroid malfunction
  • Endometriosis
  • Cancer
  • Liver or kidney disease

Menorrhagia is most likely caused by hormone imbalance, which produces menstrual cycles lacking ovulation. Hormonal changes are most common in adolescents, and women in their 40­50s approaching menopause.

These methods will be used to investigate menorrhagia: ­

  • Blood test
  • Ultrasound
  • Endometrial biopsy (tissue sample)

Once investigated, the following treatments are available: ­

  • Anti­-inflammatory medication
  • Oral contraceptive pill (OCP)
  • Tranexamic acid
  • Surgical hysteroscopy
  • Polypectomy
  • Myomectomy
  • Other alternative treatments.

Dysfunctional uterine bleeding (DUB) is abnormal bleeding from the vagina that is due to changes in hormone levels and not pregnancy, medical conditions, miscarriage or other causes.


There are several symptoms for dysfunctional uterine bleeding including:

  • Bleeding or spotting from the vagina between periods
  • Periods that occur less than 28 days or more than 35 days apart
  • Time between periods changes each month
  • Bleeding that lasts for more than 7 days
  • Heavier bleeding (such as passing large clots, needing to change protection during the night, soaking through a sanitary pad or tampon every hour for 2 or 3 hours in a row)


Treatments for this problem are categorised into two groups; hormonal and non-hormonal.

  • Hormonal treatment will be considered for women with conditions that are listed below:
    • For young patients up to age 18 a low-dose combination birth control pills treatment is recommended.
    • High-dose estrogen therapy for women with heavy bleeding
    • Low dose birth control pills
    • Intrauterine device (IUD) that releases the hormone progestin
  • Non-hormonal treatment will be considered for women with severe symptoms and do not get better with other treatment methods. These non-hormonal treatments are:
    • A surgical procedure to destroy or remove the lining of the uterus
    • Hysterectomy to remove the uterus