Heavy or prolonged bleeding in menstrual period

Menorrhagia is defined as menstruation periods at regular cycle but with excessive flow which may last more than 7 days. Menorrhagia can cause menstrual bleeding of more than 80 mL in each cycle. Menorrhagia is a major cause of gynaecological diseases that affect 1–5 women living in Europe and North America in a period of their reproductive age. This proportion shows similar frequency in developing countries as well. 

Causes may be due to abnormal blood clotting, disruption of normal hormonal regulation of periods or disorders of the endometrial lining of the uterus. Depending upon the cause, it may be associated with abnormally painful periods. The complications related with menorrhagia could also be the initial symptoms. Excessive bleeding can lead to anaemia (low concentration of red blood cells in blood) which presents as fatigue, shortness of breath and weakness. 

The most common endocrinologic cause of menorrhagia is anovulatory bleeding usually seen in adolescent and perimenopausal populations. Anatomic causes such as polyps and submucous fibroids are common in premenopausal women. Rarely, prolactin-producing tumours can cause menorrhagia. A quite rare condition leading to menorrhagia is the endometrial cancer.

Menorrhagia has negative effects on women’s quality of life. Therefore, quality of life of the women consulting the clinics with menorrhagia complaint should be investigated and effective approaches should be designed accordingly.

Uterine fibroids

The most common benign smooth muscle tumours of the uterus encountered in women of reproductive age. Typically, fibroids appear as well-defined, solid masses with a whorled appearance. Uterine fibroids grow from the uterine muscle and are under the hormonal influence of oestrogen (sex hormone), that is why they do not exist before the secretion of this hormone before puberty, and they regress with menopause. Menorrhagia is one of the important symptoms of this disease. 

Uterine polyps

Endometrial polyps are benign localized lesions of the endometrium, which are commonly seen in women of reproductive age. They appear to be affected by hormone levels and grow in response to circulating oestrogen. Uterine polyps often manifest by menorrhagia. 

Adenomyosis

Adenomyosis is a benign gynaecological condition characterized by the presence of endometrial glands and stroma in the myometrium. It may be found distributed within the whole uterine wall - in diffuse form - or in a limited area - as focal adenomyosis. This ectopic tissue seems to induce hypertrophy (abnormal growth of tissue due to increased cell size) and hyperplasia (abnormal growth of tissue due to increased number of cells) of the subjacent myometrium resulting in diffusely enlarged uterus. Clinical manifestations commonly include dysmenorrhea (a painful menstruation) and menorrhagia.

Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome is a condition in which a woman has an imbalance of female sex hormones and cysts in the ovaries. PCOS is a syndrome of anovulation, irregular and heavy menses, obesity, hirsutism (abnormal growth of hairs), and insulin resistance. Both hypo and hyperthyroidism (decreased and increased function of thyroidal gland) related with insulin resistance can cause menorrhagia due to hormonal imbalances affecting also reproductive tract.

Von Willebrand Disease (bleeding diorders)

Von Willebrand disease is the most common inherited bleeding disorder, and it affects both men and women equally. Von Willebrand disease is similar to haemophilia in that it involves a deficiency in the ability of blood to clot properly. Those affected by von Willebrand disease will have low levels of von Willebrand factor, a protein that helps the blood to clot, and/or their von Willebrand factor does not work properly. Among other symptoms, the heavy menstrual bleeding is present due to low clotting capacity.