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Heavy Menstrual Bleeding: Causes and Treatment

Menorrhagia, commonly referred to as Heavy Menstrual Bleeding (HMB) or Hypermenorrhea, is when a woman experiences an abnormally heavy menstrual flow. HMB is when a woman experiences excessive vaginal bleeding of more than 80 ml of blood loss In this condition, periods can prolong for seven or more days with extreme bleeding, and there may also be a large clot formation.

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Puberty Menorrhagia

Puberty menorrhagia is a condition where there is an excessive amount of bleeding during menstruation (>80 ml) or duration (> seven days) between menarche and 19 years of age. Menarche is a hallmark event in the life of most adolescent girls. This signifies the shift from childhood to adolescence.

  1. Anovulatory cycles are adolescents' most frequent cause of Heavy Menstrual Bleeding (HMB)
  2. Reassurance, non-hormonal treatments, and observation can manage mild bleeding if normal hemoglobin levels are maintained
  3. The goal of hormonal therapy is to stabilize the endometrium. Other possible causes of menorrhagia include:
  • A hormonal imbalance can lead to heavy menstrual bleeding. The hormones estrogen and progesterone typically keep the uterine lining (endometrium) buildup in check during the menstrual cycle. But if the hormones become imbalanced, the endometrium can develop too much and cause heavy bleeding during menstruation.
  • Various factors can lead to hormone imbalances, such as polycystic ovary syndrome (PCOS), obesity, insulin resistance, and thyroid issues.
  • Women may develop noncancerous tumors in their uterus called uterine fibroids during their reproductive years. These fibroids can cause heavier and longer menstrual bleeding than usual.
  • Small and harmless growths called polyps can develop on the uterus lining, leading to heavy or prolonged menstrual bleeding.
  • Adenomyosis is a medical condition where the glands from the endometrium get embedded in the uterine muscle. This can lead to heavy bleeding and painful periods for those affected.
  • Using a non-hormonal intrauterine device (IUD) for birth control can cause menorrhagia, a commonly known side effect.
  • Uterine cancer and cervical cancer are potential causes of heavy menstrual bleeding.
  • Conditions like Von Willebrand's disease can cause abnormal menstrual bleeding due to a blood-clotting factor deficiency or impairment.
  • Some medications can cause heavy or prolonged menstrual bleeding. These include anti-inflammatory drugs, hormonal medications like estrogen and progestins, and anticoagulants such as warfarin or enoxaparin.
  • Menorrhagia may be associated with conditions like liver or kidney disease

Medications Used to Treat Heavy Menstrual Bleeding

Iron supplements- Improves well-being of the patient NSAIDs- Can ease cramps and reduces bleeding.

  • Hormonal treatments like birth control pills can help with heavy menstrual bleeding by restoring estrogen and progesterone levels.
  • Tranexamic acid and other antifibrinolytic medications work by inhibiting blood clots' breakdown, which helps prevent excessive bleeding.

Procedures Used to Treat Heavy Period Bleeding

Hysteroscopy is a common method for identifying and treating excessive menstrual bleeding. It involves using a precise surgical tool called a Hysteroscope inserted into the uterine cavity for inspection and possible intervention.

Other procedures include:

  • Laparoscopic Myomectomy is a procedure for removing fibroids from the uterus.
  • Uterine artery involves embolization, which restricts blood flow to the affected area.
  • Endometrial ablation, which destroys either the entire or a portion of the uterus lining
  • Total laparoscopic hysterectomy, which involves the removal of the uterus entirely.


The treatment options for abnormally heavy bleeding vary depending on the root cause. They may involve hormonal birth control, hormonal therapy, medications that lower the amount of bleeding, or surgical procedures. Women with benign heavy menstrual bleeding can choose many medical and surgical treatment options to reduce their blood loss and improve their quality of life.

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