9 Causes of Heavy Menstrual Bleeding

What Might Be Behind Your Heavy Flow

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Many of us, from time to time, experience what we feel is unusually heavy bleeding during our menstrual period. Fortunately, what we often think of as abnormal uterine bleeding is not excessive enough to be diagnosed as menorrhagia.

How Do You Know When Your Menstrual Bleeding Is Abnormally Heavy?

The easiest way to know if you are experiencing menorrhagia is to take note of how often you need to change your pad or tampon.

If your period is heavy enough to require changing more often than every one or two hours, or if you have a period that lasts more than a full week, you may be experiencing menorrhagia.

What Are the Most Common Causes of Menorrhagia or Heavy Menstrual Bleeding?

1. Hormones. A hormonal imbalance during adolescence or menopause is the most common cause of heavy menstrual bleeding. During adolescence, after girls have their first periods and for several years before the onset of menopause, our hormone levels are fluctuating, which often leads to excessive uterine bleeding during our periods.

It’s often possible to treat menorrhagia caused by hormonal imbalances with birth control pills or other hormones.

2. Uterine fibroid tumors. It’s important to understand that fibroid tumors are usually benign (non-cancerous). They often occur in the uterus during a woman's 30s or 40s. While the cause of uterine fibroid tumors is unclear, it is known that they are estrogen-dependent.

Several surgical treatments are available, including myomectomy, endometrial ablation, uterine artery embolization, and uterine balloon therapy, as well as hysterectomy. Non-surgical pharmacological treatments include GnRH agonists and oral contraceptives. Some women find natural progesterone to be an effective treatment.

Often, when symptoms are not severe or troublesome, a “wait and see” approach is taken. Once menopause occurs, uterine fibroid tumors typically shrink and disappear without treatment.

3. Cervical polyps. These are small, fragile growths that begin in either the mucosal surface of the cervix or the endocervical canal, and which protrude through the opening of the cervix. The cause of cervical polyps is not clear; however, they are often the result of an infection and are also associated with an abnormal response to increased estrogen levels or congestion of the blood vessels in the cervix. Women most commonly affected by cervical polyps are those over the age of 20 who have had children.

A simple outpatient office procedure can be done to remove the growth, followed by antibiotics.

4. Endometrial polyps. These are typically non-cancerous growths that protrude from the lining of the uterus. The cause of endometrial polyps is unclear, though they are often associated with an excess of estrogen following hormone treatment, or even with some types of ovarian tumors.

Treatments for endometrial polyps include hysteroscopy and D&C. A pathology lab will evaluate endometrial polyps for cancer following their removal.

5. Pelvic inflammatory disease (PID). This is when one or more organs are infected and affects the uterus, fallopian tubes, and cervix. PID is, most often, a sexually transmitted infection; however, it sometimes occurs following childbirth, abortion, or other gynecological procedures.

The recommended treatment for PID is antibiotic therapy.

6. Cervical cancer. This is a type of cancer that occurs when cells in the cervix become abnormal, multiply out of control, and damage healthy parts of the body. The human papillomavirus, or HPV, is the cause of over ninety percent of all cervical cancers.

Treatments for cervical cancer include surgery, chemotherapy, and radiation therapy.

7. Endometrial cancer. This cancer occurs when abnormal cells in the uterus or the endometrium (the lining of the uterus) multiply out of control and damage the uterus and other organs. While the cause of endometrial cancer is unknown, it is known that women diagnosed with this type of cancer tend to be over 50, often have endometrial hyperplasia, or use hormone replacement therapy (HRT).

The first treatment for endometrial cancer is usually a hysterectomy, possibly followed by chemotherapy and/or radiation treatments.

8. IUDs or intrauterine devices. IUDs used for contraception are a potential cause of heavy menstrual bleeding or menorrhagia. Women who experience prolonged or heavy periods while using the IUD should have the device removed and choose an alternate method of birth control.

9. Bleeding disorders. This is when it is hard for a person to stop bleeding. While there are several types of bleeding disorders, the most common type in women is von Willebrand Disease or VWD. Treatments for von Willebrand Disease involve the release of stored clotting factors in the blood or, in extreme cases, replacing the clotting factor with an IV treatment or with a prescribed nasal spray.

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