What is heavy uterine bleeding?

Heavy uterine bleeding (also known as menorrhagia) is excessive menstrual bleeding. Menstrual bleeding occurs during a menstrual cycle when the lining of the uterus (endometrium) breaks down and separates from the wall of the uterus when the fertilisation of an egg does not occur. Heavy uterine bleeding is a common problem in the 30-50 year age group and may be debilitating socially and health wise.

For about 50 per cent of women with heavy menstrual bleeding the cause is unknown, this has been known as dysfunctional uterine bleeding. For the other 50 per cent the cause may be related to:

• Endometrial polyps (thickening of the endometrium, usually benign (non-cancerous), looks like a large ‘tear drop’ of tissue)
• Endometrial hyperplasia (generalised thickening of the endometrium which can progress to being cancerous)
• Endometrial cancer (cancer of the uterus)
• Fibroids (benign tumours or lumps originating from the muscle of the uterus)
• Adenomyosis (endometrial cells growing in small pockets inside the muscle layer of the uterus causing pain and bleeding)
• Intra uterine device (a contraceptive device also known as an IUD), 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 such as underactive thyroid gland (hypothyroidism)
• Bleeding disorders where excessive bleeding can occur e.g. Von Willebrand disease, but is more common in teenagers
• Chronic kidney disease

How do I know if my bleeding is too heavy?

It is very difficult to work this out, but if your bleeding is becoming heavier than usual, interfering with your daily life or activities, or worrying you, then seek help.

Note: postmenopausal women should not be bleeding/spotting.

What signs should I look for?

What signs should I look for?

• Unusual increase in blood loss
• More than seven days of bleeding
• Bleeding or flooding not contained within pads or tampons (especially if wearing the largest size)
• Clots greater than a 50 cent piece in size
• Dizziness, fatigue or looking pale during your period
• Needing to change pads/tampons within 2 hours
• Waking up at night several times to change pads/tampons

How may it affect me?

• You may feel fatigued, dizzy or look pale
• You may have low iron levels because of the blood loss
• You may have cramping and pain in the lower abdomen
• The inconvenience of having to change sanitary products frequently and the fear of bleeding through to your clothes may affect your daily activities

What therapies are available?

Your health practitioner may recommend iron therapy if your iron levels are low. This is usually a tablet that is taken daily.

Your health practitioner may prescribe other medications such as: 

• Certain anti-inflammatory drugs to reduce bleeding and period pain, such as ibuprofen, mefenamic acid and naproxen sodium
• Tranexamic acid to reduce the bleeding
• An IUD, releasing a hormone which thins the endometrium and reduces bleeding up to 95 per cent after 12 months of use, for example Mirena
• The contraceptive pill to reduce period pain and provide contraception (blood flow can be reduced by up to 50 per cent by using the pill)
• Progestins (synthetic forms of progesterone, one of the female hormones) to reduce blood loss by about 30 per cent 

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

• Medicines 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.

Where can I get more information?

http://www.jeanhailes.org.au/

http://www.healthforwomen.org.au/

Further Resources

 Heavy uterine bleeding 46.93 Kb  

Content updated September 2010