What is menorrhagia and menometrorrhagia?

Heavy menstrual bleeding is also known as "menorrhagia". Menorrhagia is diagnosed when:

• Your menstrual bleeding lasts longer than over 5-6 days
• You have to change the tampon or pad after less than 2 hours
• You need to use double sanitary protection to control your menstrual flow
• You wake up to change sanitary protection during the night
• You pass clots that are the size of or bigger than grapes or a quarter
• You restrict daily activities due to heavy menstrual flow
• You have symptoms of anemia, such as tiredness, fatigue, or shortness of breath

Menorrhagia can be normal, but it can also be a sign of a problem. Menometrorrhagia is menorrhagia, heavy bleeding, that is associated with increased pelvic pain. 

How common is heavy menstrual bleeding?

Heavy bleeding (menorrhagia) affects more than 10 million American women each year and is one of the most common problems women report to their doctors. This means that about one out of every five women of childbearing age has it. But, many women do not know that their bleeding is abnormal and that they can get help for it. Others do not get help because they are too embarrassed to talk with a doctor about their problem or doctors don't ask the right questions. Talking openly with your doctor is very important in making sure you are diagnosed properly and get the right treatment.

Why is heavy menstrual bleeding a problem?

Untreated heavy or prolonged menorrhagia or bleeding can cause anemia. It can also affect your daily life. Anemia is a blood problem associated with less red blood cells and it can leave you feeling tired or weak. In addition, a menstrual bleeding problem could also be a sign of other issues and it could lead to other health problems. Sometimes treatments, such as dilation and curettage (D&C)External or a hysterectomyExternal, are done, but they could have been avoided if the right diagnosis was made in the first place.

Possible causes of heavy menstrual bleedings

• Hormone-related problems
• Uterine-related problems
• Growths or tumors of the uterus that are not cancer; can be called uterine fibroids or
• uterine polyps.
• Infections
• Endometriosis
• Cancer of the uterus or cervix.
• Certain types of birth control—for example, an intrauterine device (IUD).
• Problems related to pregnancy, such as:
• Miscarriage   
• Ectopic pregnancy
• Other illnesses or disorders
• Bleeding-related medical disorders, such as von Willebrand disease (VWD) or platelet function disorder.
• Nonbleeding-related disorders such as liver, kidney, or thyroid disease; pelvic inflammatory disease; and cancer.

In addition, certain drugs, such as aspirin, can cause increased menstrual periods and bleeding. If you have increased menstrual bleeding, and your doctor has not found any problems during your routine visit, you should be tested for a bleeding disorder such as von Willebrand disease or platelet function disorders. You should also find out if anyone in your family may have had abnormal menstrual bleeding because certain medical conditions are inherited.

Hormone imbalance and other related issues

In a normal menstrual cycle, a balance between the hormones estrogen and progesterone regulates the buildup of the lining of the uterus (endometrium). The endometrium is shed regularly during menstruation, during your menstrual period. In cases of hormone imbalance, the uterine lining, the endometrium develops in excess. Eventually, it sheds by way of heavy menstrual bleeding.

There are several abnormal conditions that can cause hormone imbalances, including:

• polycystic ovary syndrome (PCOS),
• obesity,
• insulin resistance
• thyroid problems

Tests and procedures for menorrhagia/heavy bleeding

• Blood test. To check for anemia, problems with the thyroid, or problems with the way the blood clots.
• Pap test. To check for changes in your cervical cells that might be cancer or might cause cancer.
• Endometrial biopsy. Tissue samples are taken from the inside lining of your uterus or “endometrium” to find out if you have cancer or other abnormal cells. 
• Ultrasound. 
• Sonohysterogram. This ultrasound scan is done after fluid is injected through a tube into the uterus by way of your vagina and cervix.  
• Hysteroscopy. This is a procedure to look at the inside of the uterus using a tiny tool to see if you have fibroids, polyps, or other problems that might be causing bleeding.  
• Dilation and Curettage (D&C). This is a procedure (or test) that can be used to find and treat the cause of bleeding. During a D&C, the inside lining of your uterus is scraped and looked at to see what might be causing the bleeding.