Menorrhagia (heavy menstrual bleeding) - Diagnosis and treatment (2023)



Menorrhagia (heavy menstrual bleeding) - Diagnosis and treatment (1)


During hysterosonography (his-tur-o-suh-NOG-ruh-fee), a care provider uses a thin, flexible tube (catheter) to inject salt water (saline) into the hollow part of the uterus. An ultrasound probe gets images of the inside of the uterus to check for anything unusual.


Menorrhagia (heavy menstrual bleeding) - Diagnosis and treatment (2)


During hysteroscopy, a thin, lighted instrument (hysteroscope) provides a view of the inside of the uterus.

Your doctor will most likely ask about your medical history and menstrual cycles. You may be asked to keep a diary of bleeding and nonbleeding days, including notes on how heavy your flow was and how much sanitary protection you needed to control it.

Your doctor will do a physical exam and may recommend one or more tests or procedures such as:

(Video) Abnormal Uterine Bleeding (AUB) - Menorrhagia & Heavy Menstrual Bleeding | (Including Mnemonic!)

  • Blood tests. A sample of your blood may be evaluated for iron deficiency (anemia) and other conditions, such as thyroid disorders or blood-clotting abnormalities.
  • Pap test. In this test, cells from your cervix are collected and tested for infection, inflammation or changes that may be cancerous or may lead to cancer.
  • Endometrial biopsy. Your doctor may take a sample of tissue from the inside of your uterus to be examined by a pathologist.
  • Ultrasound. This imaging method uses sound waves to produce images of your uterus, ovaries and pelvis.

Based on the results of your initial tests, your doctor may recommend further testing, including:

  • Sonohysterography. During this test, a fluid is injected through a tube into your uterus by way of your vagina and cervix. Your doctor then uses ultrasound to look for problems in the lining of your uterus.
  • Hysteroscopy. This exam involves inserting a thin, lighted instrument through your vagina and cervix into your uterus, which allows your doctor to see the inside of your uterus.

Doctors can be certain of a diagnosis of menorrhagia only after ruling out other menstrual disorders, medical conditions or medications as possible causes or aggravations of this condition.


Specific treatment for menorrhagia is based on a number of factors, including:

  • Your overall health and medical history
  • The cause and severity of the condition
  • Your tolerance for specific medications, procedures or therapies
  • The likelihood that your periods will become less heavy soon
  • Your future childbearing plans
  • Effects of the condition on your lifestyle
  • Your opinion or personal preference


Medical therapy for menorrhagia may include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), help reduce menstrual blood loss. NSAIDs have the added benefit of relieving painful menstrual cramps (dysmenorrhea).
  • Tranexamic acid. Tranexamic acid (Lysteda) helps reduce menstrual blood loss and only needs to be taken at the time of the bleeding.
  • Oral contraceptives. Aside from providing birth control, oral contraceptives can help regulate menstrual cycles and reduce episodes of excessive or prolonged menstrual bleeding.
  • Oral progesterone. The hormone progesterone can help correct hormone imbalance and reduce menorrhagia.
  • Hormonal IUD (Liletta, Mirena). This intrauterine device releases a type of progestin called levonorgestrel, which makes the uterine lining thin and decreases menstrual blood flow and cramping.

If you have menorrhagia from taking hormone medication, you and your doctor may be able to treat the condition by changing or stopping your medication.

If you also have anemia due to your menorrhagia, your doctor may recommend that you take iron supplements regularly. If your iron levels are low but you're not yet anemic, you may be started on iron supplements rather than waiting until you become anemic.


Uterine artery embolization

Menorrhagia (heavy menstrual bleeding) - Diagnosis and treatment (3)

Uterine artery embolization

Small particles (embolic agents) are injected into the uterine artery through a small catheter. The embolic agents then flow to the fibroids and lodge in the arteries that feed them. This cuts off blood flow to starve the tumors.

Focused ultrasound surgery

Menorrhagia (heavy menstrual bleeding) - Diagnosis and treatment (4)

Focused ultrasound surgery

During focused ultrasound surgery, high-frequency, high-energy sound waves are used to target and destroy uterine fibroids. The procedure is performed while you're inside an MRI scanner. The equipment allows your doctor to visualize your uterus, locate any fibroids and destroy the fibroid tissue without making any incisions.

(Video) Heavy menstrual bleeding - Menorrhagia - Causes and Treatment.

Radiofrequency ablation

Menorrhagia (heavy menstrual bleeding) - Diagnosis and treatment (5)

Radiofrequency ablation

During radiofrequency ablation, a triangular ablation device uses radiofrequency energy to destroy the tissue lining the uterus. The lining is called the endometrium. The ablation device is then removed from the uterus.

Dilation and curettage (D&C)

Menorrhagia (heavy menstrual bleeding) - Diagnosis and treatment (6)

Dilation and curettage (D&C)

During a dilation and curettage procedure (D&C), your provider uses a vaginal speculum to hold the walls of the vagina apart. Then your provider inserts a series of rods (dilators) of increasing thickness to open (dilate) your cervix and allow access to your uterus. Next, your provider inserts a long, thin instrument (curette) through your cervix into your uterus and carefully removes the tissue lining the inside of the uterus.

(Video) Heavy menstrual bleeding | Causes | Treatment | Dr. SreDevi | Gynaecologist | Tamil

You may need surgical treatment for menorrhagia if medical therapy is unsuccessful. Treatment options include:

  • Dilation and curettage (D&C). In this procedure, your doctor opens (dilates) your cervix and then scrapes or suctions tissue from the lining of your uterus to reduce menstrual bleeding. Although this procedure is common and often treats acute or active bleeding successfully, you may need additional D&C procedures if menorrhagia recurs.
  • Uterine artery embolization. For women whose menorrhagia is caused by fibroids, the goal of this procedure is to shrink any fibroids in the uterus by blocking the uterine arteries and cutting off their blood supply. During uterine artery embolization, the surgeon passes a catheter through the large artery in the thigh (femoral artery) and guides it to your uterine arteries, where the blood vessel is injected with materials that decrease blood flow to the fibroid.
  • Focused ultrasound surgery. Similar to uterine artery embolization, focused ultrasound surgery treats bleeding caused by fibroids by shrinking the fibroids. This procedure uses ultrasound waves to destroy the fibroid tissue. There are no incisions required for this procedure.
  • Myomectomy. This procedure involves surgical removal of uterine fibroids. Depending on the size, number and location of the fibroids, your surgeon may choose to perform the myomectomy using open abdominal surgery, through several small incisions (laparoscopically), or through the vagina and cervix (hysteroscopically).
  • Endometrial ablation. This procedure involves destroying (ablating) the lining of your uterus (endometrium). The procedure uses a laser, radiofrequency or heat applied to the endometrium to destroy the tissue.

    After endometrial ablation, most women have much lighter periods. Pregnancy after endometrial ablation has many associated complications. If you have endometrial ablation, the use of reliable or permanent contraception until menopause is recommended.

  • Endometrial resection. This surgical procedure uses an electrosurgical wire loop to remove the lining of the uterus. Both endometrial ablation and endometrial resection benefit women who have very heavy menstrual bleeding. Pregnancy isn't recommended after this procedure.
  • Hysterectomy. Hysterectomy — surgery to remove your uterus and cervix — is a permanent procedure that causes sterility and ends menstrual periods. Hysterectomy is performed under anesthesia and requires hospitalization. Additional removal of the ovaries (bilateral oophorectomy) may cause premature menopause.

Many of these surgical procedures are done on an outpatient basis. Although you may need a general anesthetic, it's likely that you can go home later on the same day. An abdominal myomectomy or a hysterectomy usually requires a hospital stay.

When menorrhagia is a sign of another condition, such as thyroid disease, treating that condition usually results in lighter periods.

More Information

  • Heavy periods: Can folic acid help?
  • Ablation therapy
  • Endometrial ablation
  • Hormonal IUD (Mirena)

Request an appointment

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(Video) Menorrhagia, Heavy Periods | Medical Animation

Preparing for your appointment

If your periods are so heavy that they limit your lifestyle, make an appointment with your doctor or other health care provider.

Here's some information to help you prepare for your appointment and what to expect from your provider.

What you can do

To prepare for your appointment:

  • Ask if there are any pre-appointment instructions. Your doctor may ask you to track your menstrual cycles on a calendar, noting how long they last and how heavy the bleeding is.
  • Write down any symptoms you're experiencing, and for how long. In addition to the frequency and volume of your periods, tell your doctor about other symptoms that typically occur around the time of your period, such as breast tenderness, menstrual cramps or pelvic pain.
  • Write down key personal information, including any recent changes or stressors in your life. These factors can affect your menstrual cycle.
  • Make a list of your key medical information, including other conditions for which you're being treated and the names of medications, vitamins or supplements you're taking.
  • Write down questions to ask your doctor, to help make the most of your time together.

For menorrhagia, some basic questions to ask your doctor include:

  • Are my periods abnormally heavy?
  • Do I need any tests?
  • What treatment approach do you recommend?
  • Are there any side effects associated with these treatments?
  • Will any of these treatments affect my ability to become pregnant?
  • Are there any lifestyle changes I can make to help manage my symptoms?
  • Could my symptoms change over time?

Don't hesitate to ask any other questions that occur to you during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

  • When did your last period start?
  • At what age did you begin menstruating?
  • How have your periods changed over time?
  • Do you have breast tenderness or pelvic pain during your menstrual cycle?
  • How long do your periods last?
  • How frequently do you need to change your tampon or pad when you're menstruating?
  • Do you have severe cramping during your period?
  • Has your body weight recently changed?
  • Are you sexually active?
  • What type of birth control are you using?
  • Do you have a family history of bleeding disorders?
  • Do your symptoms limit your ability to function? For example, have you ever had to miss school or work because of your period?
  • Are you currently being treated or have you recently been treated for any other medical conditions?

What you can do in the meantime

While you wait for your appointment, check with your family members to find out if any relatives have been diagnosed with bleeding disorders. In addition, start jotting down notes about how often and how much you bleed over the course of each month. To track the volume of bleeding, count how many tampons or pads you saturate during an average menstrual period.

By Mayo Clinic Staff

(Video) Menorrhagia Diagnosis And Treatment Heavy Menstrual Bleeding # DUB Part -1 #Dr. Deepak Singh # Gyn.


What is the diagnosis and treatment of menorrhagia? ›

It is caused by hormone problems, problems with the uterus, or other health conditions. Menorrhagia is diagnosed with a pelvic exam, ultrasound, pap test, and sometimes a biopsy. Treatment includes hormones, or other medicine, or procedures to treat the uterine lining or remove the uterus.

What does the ER do for menorrhagia? ›

ER doctors can administer fluids to stabilize a person. They may also give a blood transfusion or medications or, potentially, perform a medical procedure to stop the bleeding.

What is the first line treatment for menorrhagia? ›

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line medical therapy in ovulatory menorrhagia. Studies show an average reduction of 20-46% in menstrual blood flow. NSAIDs reduce prostaglandin levels by inhibiting cyclooxygenase and decreasing the ratio of prostacyclin to thromboxane.

Is menorrhagia a serious problem? ›

If you have this type of bleeding, you should see a doctor. Untreated heavy or prolonged bleeding can stop you from living your life to the fullest. It also can cause anemia. Anemia is a common blood problem that can leave you feeling tired or weak.

Can you get rid of menorrhagia? ›

Surgical treatment

Removing or destroying the lining of the womb is an option. This is called endometrial ablation. This can be done in a number of ways, using heat, laser or energy waves.

What is the root cause of menorrhagia? ›

Menorrhagia in older reproductive-age women is typically due to uterine pathology, including fibroids, polyps and adenomyosis. However, other problems, such as uterine cancer, bleeding disorders, medication side effects and liver or kidney disease could be contributing factors.

What makes menorrhagia worse? ›

Also, do your best to avoid foods with processed sugar, trans-fats and starchy carbs. These foods can make menorrhagia symptoms worse.

What can cause menorrhagia? ›

Sometimes, they can be caused by:
  • conditions affecting your womb, ovaries or hormones, such as polycystic ovary syndrome, fibroids, endometriosis and pelvic inflammatory disease.
  • some medicines and treatments, including some anticoagulant medicines and chemotherapy medicines.
  • stress and depression.

Should I go to ER for heavy menstrual bleeding? ›

Heavy menstrual bleeding, called menorrhagia, is fairly common but may lead to serious complications. Untreated heavy menstrual bleeding can cause anemia. If you experience weakness, dizziness, shortness of breath, or chest pain along with heavy menstrual bleeding, it's recommended that you seek medical attention.

Would a hysterectomy cure menorrhagia? ›

Hysterectomy — Hysterectomy is a major surgery that removes the uterus. This is a permanent treatment that cures heavy menstrual bleeding. However, the surgery can have complications and may require up to six weeks for full recovery. Pregnancy is not possible after hysterectomy.

What do I do if my period wont stop? ›

Having long periods frequently can indicate one of several potential conditions, such as endometriosis or uterine fibroids. A doctor can help diagnose and treat these conditions. Often, taking hormonal birth control pills or switching the type of hormonal medication can help people find relief.

What hormone will stop menstrual bleeding? ›

For women with menorrhagia (excessively prolonged or heavy menstruation), the administration of an estrogen may be recommended to temporarily stop the bleeding and stabilize the endometrial lining.

How long can menorrhagia last? ›

Average blood loss during menstruation is about 2–3 tablespoons , equating to 30–45 milliliters, over 4–5 days. However, a person with menorrhagia may experience bleeding that lasts longer than 7 days or heavy bleeding that causes them to soak through one or more tampons or pads every hour for several hours in a row.

What infections cause menorrhagia? ›

Infections, including sexually transmitted infections (STIs) can cause heavy bleeding. These include: Trichomoniasis. Gonorrhea.

Who gets menorrhagia? ›

The medical name for heavy periods is menorrhagia. Heavy periods are common and are more likely to develop as you get older. They are most common in women aged between 30 and 49. But only around five in every 100 women will see their GP about this.

What age is menorrhagia most common? ›

Any woman of reproductive age who is menstruating may develop menorrhagia. Most patients with menorrhagia are older than 30 years. This is because the most common cause of heavy menses in the younger population is anovulatory cycles, in which bleeding does not occur at regular intervals.

Is menorrhagia caused by stress? ›

Lifestyle factors like fluctuations in weight and high levels of stress may contribute to heavy bleeding.

What vitamin is deficient in menorrhagia? ›

Hypovitaminosis A was found to be an important cause of menorrhagia, and a statistically significant difference between the fasting serum vitamin A values of healthy controls and patients with menorrhagia was noted.

What hormone causes menorrhagia? ›

Menorrhagia can be caused by an imbalance in estrogen and progesterone levels. Some women have elevated estrogen levels and low progesterone levels. This can lead to a thickening of the uterine lining, which often results in heavy bleeding.

What does jelly like period blood mean? ›

Clumpy period blood

As your period continues, you may notice blood that's jelly-like or broken up into thick clumps. This is typically caused by blood clots that are passing through your body. This is normal during any part of your period.

Will insurance cover hysterectomy for heavy bleeding? ›

In many cases, hysterectomy—particularly if it's elective—isn't covered by insurance. Some plans may only cover hysterectomy to treat cancer or hemorrhaging (severe and life-threatening bleeding), for example.

What are the signs you need a hysterectomy? ›

The most common reasons for having a hysterectomy include:
  • heavy periods – which can be caused by fibroids.
  • pelvic pain – which may be caused by endometriosis, unsuccessfully treated pelvic inflammatory disease (PID), adenomyosis or fibroids.
  • prolapse of the uterus.
  • cancer of the womb, ovaries or cervix.

Can menorrhagia lead to hysterectomy? ›

Hysterectomy as a treatment for heavy menstrual bleeding

We can often treat heavy menstrual bleeding at the menorrhagia level. Before we consider hysterectomy as the treatment, which removes the uterus and makes pregnancy impossible, we make sure to consider or try other options.

What to do if period lasts more than 10 days? ›

If you suspect your period is lasting longer than usual or you have heavy bleeding with your periods, don't hesitate to contact your doctor. It's important to find the cause of longer or heavier periods to not only rule out more concerning medical conditions but to improve your overall quality of life.

How much lemon juice to drink to stop period? ›

Drinking a shot of lemon juice won't delay your period or make it stop. Using a hormonal birth control method is the only way to lighten or control when you get your period: When taking a hormonal birth control method, like the pill, ring, and patch, you have the ability to skip your period.

Why have I been bleeding for over a month? ›

Abnormal uterine bleeding is bleeding between monthly periods, prolonged bleeding or an extremely heavy period. Possible causes include fibroids, polyps, hormone changes and — in rare cases — cancer.

What can doctors do to stop menstrual bleeding? ›

Tranexamic acid helps your blood to clot, which will reduce the bleeding. It comes as a tablet that you take during your period. Non-steroidal anti-inflammatory drugs (NSAIDs) reduce the amount of prostaglandin in the lining of your uterus, as prostaglandin seems to contribute to heavy bleeding and pain.

What is the clinical diagnosis of menorrhagia? ›

Menorrhagia is a symptom of an underlying pathology in many women. It is defined as excessive bleeding (over 80 ml of blood per period), for over 7 days and at regular intervals.

How do you diagnose menorrhagia? ›

The diagnosis of HMB is mostly a combination of one of the following imaging tests: transvaginal ultrasonography (TVS); saline infusion sonography (SIS); hysteroscopy; and MRI. Anatomical abnormalities of uterine muscle and cavity, such as polyps, fibroids or adenomyosis, can be visualized by using these techniques.

What is the diagnostic criteria for menorrhagia? ›

The classic definition of menorrhagia (i.e., greater than 80 mL of blood loss per cycle) is rarely used clinically. Women describe the loss or reduction of daily activities as more important than the actual volume of bleeding.

What are the red flags of menorrhagia? ›

Common Signs & Symptoms

Having to change your pad or tampon during the night. Periods that last more than seven days. Having blood clots the size of a quarter during your period. Having a flow so heavy that you can't do certain activities.

What is the common cause of menorrhagia? ›

Menorrhagia in older reproductive-age women is typically due to uterine pathology, including fibroids, polyps and adenomyosis. However, other problems, such as uterine cancer, bleeding disorders, medication side effects and liver or kidney disease could be contributing factors.

What is the most important investigation in cases of menorrhagia? ›

Hence, the most important investigations are a full blood count, a diagnostic hysteroscopy and endometrial sampling.

Can menorrhagia be life threatening? ›

Bleeding this heavily can be serious or even life threatening. If you have heavy menstrual bleeding, your health care provider will want to perform a physical exam, including a pelvic exam. They might recommend other tests, based on what they find during the exam.

How much bleeding is considered menorrhagia? ›

Average blood loss during menstruation is about 2–3 tablespoons , equating to 30–45 milliliters, over 4–5 days. However, a person with menorrhagia may experience bleeding that lasts longer than 7 days or heavy bleeding that causes them to soak through one or more tampons or pads every hour for several hours in a row.

What is menorrhagia almost a doctor? ›

Menorrhagia describes abnormally heavy menstrual bleeding (often associated with increased period pain) during periods. Menorrhagia is a common presenting compliant, and a cause is not always found. Endometrial carcinoma should always be considered as a differential.

Should I go to the ER for menorrhagia? ›

Heavy menstrual bleeding, called menorrhagia, is fairly common but may lead to serious complications. Untreated heavy menstrual bleeding can cause anemia. If you experience weakness, dizziness, shortness of breath, or chest pain along with heavy menstrual bleeding, it's recommended that you seek medical attention.

What age does menorrhagia start? ›

Any woman of reproductive age who is menstruating may develop menorrhagia. Most patients with menorrhagia are older than 30 years. This is because the most common cause of heavy menses in the younger population is anovulatory cycles, in which bleeding does not occur at regular intervals.

What is the difference between menorrhagia and menorrhagia? ›

What is the difference between menorrhagia and menometrorrhagia? Menometrorrhagia was once an umbrella term for two different conditions that sound nearly the same: Menorrhagia: excessive and/or prolonged menstruation. Metrorrhagia: excessive, prolonged and/or irregular bleeding unrelated to menstruation.


1. Adolescent Menorrhagia | Heavy Menstrual Bleeding |Diagnosis and Treatment
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2. What Causes Heavy Menstrual Bleeding (Menorrhagia) |Causes Of Heavy Menstrual Bleeding
(Med Today)
3. Menorrhagia (Heavy Menstrual Bleeding)
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4. Medically Speaking: Heavy Menstrual Bleeding & Bleeding Disorders
(Texas Children’s Hospital)
5. Heavy Menstrual Bleeding: Menorrhagia – Cause & Treatment - Antai Hospitals
(RSA Institute - English Channel)
6. Menorrhagia: a gyneacologists guide to heavy menstrual bleeding
(HEALTHISTA TV | The Art of Wellness™)


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