Heavy Uterine Bleeding

Health Topic Finder

For information on a particular condition or topic try our health Topic Finder with links to this and other Jean Hailes websites or use the website search function.

Everyday lifestyle changes are a more realistic and effective way than dieting to manage weight and prevent long-term weight gain.

Poll

Do you diet?

read the related article >>

Home

Health issues

Heavy Uterine Bleeding

|

What is heavy uterine bleeding?

Heavy uterine or menstrual bleeding (also known as menorrhagia) refers to excessive or prolonged menstrual bleeding. It is technically defined as blood loss greater than 80ml per cycle or periods lasting more than seven days. Heavy menstrual bleeding affects about 1 in 5 women, and 40 per cent of women who have a blood loss of more than 80ml report it as normal¹.

How do I know if my bleeding is too heavy?

It is very difficult to determine whether your bleeding is too heavy², so diagnosis is made on the following criteria:

changing a pad or tampon every hour
changing a pad overnight
clots greater than a 50 cent piece in size
bleeding for more than seven days

How can heavy menstrual bleeding affect me?

you may feel fatigued, exhausted, dizzy
you may have low iron (ferritin) levels because of the blood loss
the inconvenience of having to change sanitary products frequently and the fear of bleeding through to your clothes may affect your daily activities

What causes it?

About 50 per cent of women with heavy menstrual bleeding have no abnormalities in their uterus. This bleeding is called dysfunctional uterine bleeding (DUB). DUB is often related to hormonal or prostaglandin (chemical) levels in the endometrium (internal lining of the uterus). In the other 50 per cent of cases, the cause may be related to:

pregnancy or complications of pregnancy
endometrial polyps: usually non-cancerous (benign) growths that arise from the endometrium and looklike a large ‘teardrop’ of tissue
endometrial hyperplasia: an overgrowth of the endometrium, which can progress to cancer
endometrial cancer: cancer of the uterus
fibroids: non-cancerous growths or lumps within the uterus wall, which may cause bleeding depending on their position
adenomyosis: endometrium growing in small pockets inside the muscle layer of the uterus causing pain and bleeding
intrauterine device (IUD) a contraceptive device, usually of the non-hormone releasing type

There may also be a range of other possible causes that are not as common, such as:

hormonal disorders, e.g. underactive thyroid gland (hypothyroidism)
bleeding disorders where excessive bleeding can occur, e.g. Von Willebrand disease (more common in teenagers)
chronic kidney or liver disease

Note: postmenopausal women should not have any vaginal bleeding/spotting.

How is it diagnosed?

After a thorough history and clinical examination (including a pap smear and swabs) your GP may order blood tests and/or a pelvic ultrasound to eliminate some of the possible causes listed previously. The gold standard is to perform an endometrial biopsy (curette) in all women over 35 years of age with heavy menstrual bleeding to rule out endometrial hyperplasia or cancer^3,4.

How is it treated?

Your health practitioner may recommend iron therapy if your iron levels are low. This usually involves taking an iron supplement daily.

Your health practitioner may prescribe medications to reduce bleeding, such as:

anti-inflammatory drugs mefenamic acid⁵ or tranexamic acid⁶
the Mirena intrauterine device (IUD), which releases a hormone that thins the endometrium and reduces bleeding up to 95 per cent after 12 months⁷
the contraceptive pill (blood flow can be reduced by up to 50 per cent by using the pill⁸ and it can also reduce period pain)
progestins (synthetic forms of progesterone) to reduce blood loss by about 30 per cent

Surgery such as endometrial ablation (removal of endometrium) or hysterectomy is recommended if:

medications fail to reduce bleeding
there are other symptoms, such as pain
you discuss the options with your health practitioner and you both feel it is the most appropriate treatment

References

Hallberg L, Higdahl AM, Nilsson L. Menstrual blood loss – a population study. Variation at different ages and attempts to define normality. ACta Obstet Gynaecol Scand 1966; 45:320
Fraser IS, McCarronG, Markham R. A preliminary study of factors influencing perception of menstrual blood loss volume. Am J Obstet Gynecol 1984; 149:788
Bayer SR, DeCherney AH. Clinical manifestations and treatment of dysfunctional uterine bleeding JAMA 1993; 269:1823
Dijkhuizen FP, MolBW, Brolmann HA, Heintz AP. The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer 2000; 89:1765
van Eijkeren MA, Christiaens GC, Geuze HJ, Haspels AA, Sixma JJ Effects of mefenamic acid on menstrual hemostasis in essential menorrhagia. Am J Obstet Gynecol. 1992;166(5):1419
Preston JT, Cameron IT, Adams EJ, Smith SK. Comparative study of tranexamic acid and norethisterone in the treatment of ovulatory menorrhagia.Br J Obstet Gynaecol. 1995;102(5):401.
Stewart A, Cummins C, Gold L, Jordan R, Phillips W The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: a systematic review. BJOG. 2001;108(1):74
Jensen JT, Parke S, Mellinger U, Machlitt A, Fraser IS Effective treatment of heavy menstrual bleeding with estradiol valerate and dienogest: a randomized controlled trial. Obstet Gynecol. 2011;117(4):777

Further Resources

Menstrual Cycle

pdf Heavy uterine bleeding factsheet 91.62 Kb

Content updated 6 January 2012