As any group of women discussing the topic will realize, the monthly menstrual period varies widely from one woman to the next. Some women typically have light periods, while others are accustomed to heavier bleeding. Age matters too, as menopause can bring changes, including periods that are longer, shorter, heavier, or lighter. Likewise, menstrual cycles can vary at puberty and during adolescence. 

But if a period lasts more than seven days and is also very heavy, it could be a sign of a condition called menorrhagia, or heavy menstrual bleeding.

Although many report heavy menstrual bleeding, most women don't experience blood loss severe enough to be defined as menorrhagia. This is not only inconvenient and uncomfortable, it can signal more serious health conditions. Losing so much blood each month can also lead to anemia (low red blood cell count).

Fortunately, there are a number of treatments that can alleviate the discomfort of menorrhagia and also address underlying problems. At Yale Medicine, our doctors are experienced at treating a variety of bleeding disorders in women.

The classic symptoms of menorrhagia are: having a period that lasts more than a week and soaking through a tampon or sanitary pad every hour for several consecutive hours.

Other symptoms may include the following:

• Passing blood clots larger than a quarter
• Needing to use double sanitary protection (such as two pads)
• Waking up to change sanitary protection during the night Exhibiting symptoms of anemia (feeling tired or shortness of breath)

Heavy menstrual bleeding can be caused by many different factors, including the following: 

• Fibroids and polyps: These growths, which are typically noncancerous, form in or on the uterine wall and can cause excessive bleeding.
• Adenomyosis: In this condition, the inner lining of the uterus breaks through the wall of the uterus and causes heavy bleeding.
• Ovulation issues: If you don’t ovulate regularly, parts of the uterine lining may become too thick. This can occur in women with polycystic ovary syndrome, which is a hormonal disorder causing enlarged ovaries with small cysts. It can also occur in women with hypothyroidism, which is when the thyroid gland doesn’t produce enough of the thyroid hormone.
• Cancer: Heavy menstrual bleeding can be an early sign of uterine cancer.
• Bleeding disorders: Conditions such as von Willebrand disease (a genetic disorder caused by low levels of clotting protein in the blood) and others can cause menorrhagia.
• Endometriosis: This condition, in which the uterine lining grows outside the uterus, can cause menorrhagia.
• Pregnancy problems: Ectopic pregnancy (when the fertilized egg implants outside the uterus) and miscarriage can cause heavy menstrual bleeding.
• Pelvic inflammatory disease: Symptoms of this infection of the reproductive organs include heavy menstrual bleeding. 

Medications, such as aspirin, can cause increased bleeding in women. Sometimes, doctors cannot determine the cause of menorrhagia in women.

To make a diagnosis of menorrhagia, your Ob/Gyn will want to discuss your medical history, including any prior pregnancies, illnesses, and birth control methods. Additionally, your Ob/Gyn will ask for a detailed history of your menstrual cycle.

Your doctor will perform a physical exam, including a pelvic exam, and may order the following tests:

• Blood tests: These can check for anemia, thyroid, and clotting issues.
• Ultrasound: This uses sound waves to show what your blood vessels, organs, and tissues look like and how they are working.
• Pap test: Also known as a “Pap smear,” this entails removing cells from your cervix to look for changes that could signify infection, inflammation, or cancer.
• Endometrial biopsy: This involves taking tissue samples from inside your uterine lining to look for abnormal cells or cancer. 

If your doctor is still unclear about the cause or if these tests reveal issues that need further exploration, the following tests may be done:

• Hysteroscopy: This procedure uses a thin, lighted tube that is inserted through the vagina to examine the inside of your uterus to look for fibroids, polyps, or other problems.
• Sonohysterogram: This is a type of ultrasound exam in which saline is injected into the uterus by a thin tube inserted in the vagina. This provides more detailed images of the lining of the uterus.

Medications are typically the first method of treatment for menorrhagia.

• Birth control medications (the “pill,” patch, ring, or shot): These can help regulate your period and reduce the amount of bleeding.
• Intrauterine devices (IUD): These small devices, placed inside the uterus to prevent pregnancy, can also reduce or even eliminate menstrual bleeding.
• Antifibrinolytics: These medications slow menstrual bleeding by helping your blood-clotting system. 
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications include ibuprofen and can help reduce menstrual bleeding.

If medication does not reduce your bleeding, surgery may be recommended, although it may affect future fertility. 

• Myomectomy: This surgery, which can be done through the vagina or through the abdomen (via small minimally invasive incisions), is done to remove fibroids or polyps in your uterus.
• Endometrial ablation: This treatment destroys or removes much of the uterine lining to reduce bleeding.
• Hysterectomy: This surgery, which involves removing the uterus, cures heavy bleeding. It  can be performed several different ways, including using minimally invasive techniques.

The physicians from Yale Medicine Obstetrics, Gynecology & Reproductive Sciences bring together a vast array of experience and expertise.

Menorrhagia is a common disorder that can be caused by a host of factors. Our subspecialists in reproductive endocrinology and minimally invasive surgery in particular are accustomed to working with women who struggle with this condition.

“We treat the full spectrum of menstrual disorders across a woman’s lifespan, thus helping to achieve her fertility goals, reducing medical morbitities, and ensuring that heavy menses does not negatively impact her quality of life,” says Meagan Haynes, MD, MPH, a Yale Medicine Ob/Gyn.