What causes heavy menstrual bleeding? Is it dangerous?

Heavy Menstrual Bleeding (Menorrhagia) is a condition many women experience, but often overlook because they may not realize what excessive menstrual bleeding actually is or how dangerous it can be. Today, we will discuss what abnormal heavy menstrual bleeding is, its causes, how much is considered too much and when you should see a doctor. We’ll also cover the possible complications or associated conditions, available treatments, and how to prevent it.

Heavy Menstrual Bleeding (Menorrhagia) refers to menstruation in which the amount of bleeding is heavier than normal or lasts longer than usual. This condition may vary from person to person. Most women have their periods for no more than 7 days, with heavier flow typically occurring during the first 3 days and gradually decreasing in the following days. However, if bleeding continues for more than 7 days or is so heavy that you need to change sanitary pads every hour throughout the day, it may indicate that you are experiencing abnormal heavy menstrual bleeding.

Common Symptoms of Heavy Menstrual Bleeding (Menorrhagia) include:

• Having a period that lasts more than 7 consecutive days

• Bleeding so heavily that you need to change your sanitary pad every hour throughout the day

• Bleeding so heavily that you need to change your sanitary pad during the night

• Passing large blood clots frequently along with your menstrual flow

Causes of Heavy Menstrual Bleeding (Menorrhagia)

1. Hormonal Imbalance
   An imbalance of sex hormones—particularly estrogen and progesterone—can disrupt the ovulation process and menstrual cycle, leading to heavier menstrual bleeding than normal.

2. Bleeding Disorders
   Abnormal bleeding caused by blood clotting issues (e.g., blood doesn’t clot properly) can result in excessive bleeding, including heavy menstrual flow.

3. Uterine Problems

• Adenomyosis – endometrial tissue grows into the muscular wall of the uterus

• Endometriosis – endometrial tissue grows outside the uterus

• Polycystic Ovary Syndrome (PCOS) – affects hormone levels and ovulation

• Uterine fibroids – benign tumors that can increase menstrual bleeding

• Polyps – growths in the cervix or uterus

• Cancer – such as cervical or endometrial cancer

1. Contraceptive Methods
   Hormonal contraceptives like birth control pills, injections, implants, or patches can affect hormone levels and suppress ovarian function, which may cause abnormal or heavier bleeding.

2. Certain Medications
   Medications such as blood thinners, aspirin, or clot-dissolving drugs can increase bleeding.

3. Underlying Health Conditions
   Some diseases may affect the menstrual cycle and cause heavy bleeding, including:

• Pituitary tumors

• Thyroid disorders

• Blood clotting disorders, like low platelet count

• Liver or kidney disease, which can interfere with blood clotting

• Infections in the uterus or vagina, which may also cause increased vaginal discharge along with heavy menstruation.

Factors that May Increase the Risk of Heavy Menstrual Bleeding:

• Chronic health conditions, such as uterine fibroids, liver disease, kidney disease, or cervical cancer

• History of miscarriage

• History of ectopic pregnancy

• Use of medications that affect blood clotting, such as blood thinners, clot-dissolving medications, or aspirin

• Age – Research has shown that people under the age of 29 may be at higher risk of experiencing heavy menstrual bleeding

• Regular alcohol consumption

Heavy menstrual bleeding is often associated with unexpected diseases, not just cancer, but also other concerning conditions such as:

• Uterine fibroids: In the early stages, uterine fibroids may not show any symptoms, and menstruation may still occur normally. Although the risk of these fibroids becoming cancerous is low, if they grow large enough to press on nearby organs, they can cause problems.

• Endometriosis: This condition occurs when the cells of the uterine lining grow in places outside the uterus. If it grows on the ovaries, it can cause cysts filled with fluid similar to chocolate (Chocolate cyst). If it invades the muscle of the uterus, it can cause the uterus to enlarge abnormally (Adenomyosis). Both of these conditions typically cause painful menstruation, pain during sexual intercourse, and severe pain during bowel movements during menstruation, and they can also contribute to infertility.

• Ovarian cysts: These can either resolve on their own or may not. In cases other than chocolate cysts, patients may not experience any symptoms, but sometimes, they may experience acute lower abdominal pain. If complications arise, such as the twisting of the ovarian cyst, emergency surgery may be necessary.

1. Blood Tests
   Blood tests are conducted to check for abnormalities such as blood clots, anemia, or thyroid issues.

2. Endometrial Biopsy
   An endometrial biopsy involves taking a sample of the uterine lining, either through suction or scraping, for pathological examination. This can help diagnose conditions like endometrial cancer, cervical cancer, or anovulation (lack of ovulation).

3. Ultrasound Examination
   An ultrasound is used to visualize the tissues of the pelvic organs to check for any abnormalities in the uterus, endometrium, and ovaries, such as uterine fibroids, endometrial polyps, or ovarian tumors.

4. Hysteroscopy
   A hysteroscopy involves inserting a small camera into the uterus to examine the uterine cavity for abnormalities like tumors, polyps, adhesions, or blocked fallopian tubes.

Heavy menstrual bleeding (Menorrhagia) can lead to complications such as:

1. Anemia due to excessive blood loss, which in severe cases can lead to shock.

2. Chronic pelvic pain.

3. Infertility.

4. Ectopic pregnancy.

5. Formation of adhesions in the pelvic area.

1. Medication
   Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in reducing menstrual pain and the amount of menstrual blood flow.
   Hormonal treatments, such as for younger women with ovulation issues.

2. Surgical treatment
   Surgery to remove fibroids or polyps inside the uterus, dilation and curettage (D&C), endometrial ablation, or in severe cases, a hysterectomy (removal of the uterus).

Heavy menstrual bleeding can be caused by various factors, some of which may lead to infertility, such as:

1. Hormonal Imbalance: When estrogen levels are not functioning properly, it can result in the overproduction or thickening of the endometrial lining, affecting menstrual flow.

2. Uterine Issues: The uterus plays a significant role in menstruation. Any abnormalities, such as fibroids, pelvic inflammatory disease, or endometriosis, can impact menstrual cycles and fertility.

3. Side Effects from Treatments or Medications: The use of hormones, chemotherapy, or intrauterine devices (IUDs) can influence menstrual bleeding patterns.

4. Body Malfunctions or Certain Diseases: Conditions affecting the body's functions, such as thyroid disorders or blood clotting problems, can also lead to excessive menstrual bleeding.

Since heavy menstrual bleeding can lead to anemia, self-care and choosing foods high in iron, such as liver, red meat, eggs, whole grains, and leafy green vegetables, can help nourish the blood and reduce the risk of anemia caused by heavy menstrual bleeding. Additionally, iron supplements can be another option to boost iron levels in the body.

What does it mean if you have heavy periods?
If your periods are excessively heavy, it could indicate a problem with your reproductive system. It’s important to consult a specialist to examine your vagina and cervix for any lumps, sores, or growths to check for infections or inflammation.

Why do periods contain blood clots?
Typically, during menstruation, hormonal changes cause the uterine lining to shed, which causes small blood vessels to bleed. To prevent excessive blood loss, plasma and platelets work together to form blood clots that help stop bleeding from other parts of the body.

How much bleeding during your period is considered abnormal?

• Bleeding that lasts more than 7 days

• Severe abdominal pain

• Needing to change sanitary pads every 2-3 hours or continuously passing blood clots

Menorrhagia is when a woman experiences heavy menstrual bleeding or menstruation that lasts longer than 7 days. This can be dangerous as it may signal underlying conditions such as endometriosis, polycystic ovary syndrome (PCOS), fibroids, or even cancer. Moreover, heavy menstrual bleeding can lead to complications like anemia, chronic abdominal pain, or ectopic pregnancy.

If you notice that your periods are unusually heavy, it's important not to ignore it. It's advisable to consult a doctor for a proper diagnosis. However, if you're unable to visit a doctor right away, you can inquire about preliminary information via Line@ : @beyondivf