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Menstrual Periods - Heavy, Prolonged or Irregular - Symptom Evaluation

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An understanding of the causes of menstrual period abnormalities is necessary for correct diagnosis and effective treatment.

Heavy, prolonged and irregular menstrual periods can interfere with the day-to-day functioning of a woman. Besides, it could also lead to iron deficiency and anemia. In medical terms, this condition is described as menometrorrhagia. To be more precise, menometrorrhagia is defined as irregular bleeding along with either a heavy flow of more than or equal to 80mL per cycle or lasting for a duration of more than 7 days.

Menometrorrhagia is controlled by treating the underlying cause. In most uterine-related causes, treatment involves pain reduction with painkillers, hormonal treatments and sometimes surgery. In patients with bleeding disorders and thyroid hormone abnormalities, the bleeding normalizes after treating the underlying condition. Iron supplementation is often necessary. In rare cases, the bleeding may be excessive so as to necessitate blood transfusion.

Causes of heavy menstrual bleeding are:

Local Uterine and Ovarian Causes: These include:

Bullet Fibroids: Fibroids are benign tumors of the muscle of the uterus. They cause heavy bleeding. Other symptoms include pelvic pain and pressure, discomfort during sexual intercourse and a need to urinate frequently.

Bullet Polyps: Endometrial polyps are outpouchings of tissue from the inner lining of the uterus that remain attached to the inner lining by means of a stalk. Symptoms include vaginal discharge, vaginal bleeding after intercourse, and irregular, heavy and painful menstrual periods. Polyps are removed through surgery, cautery or laser therapy.

Bullet Infection: Infection especially with sexually transmitted diseases like gonorrhea and chlamydia can cause excessive bleeding. The patient also complains of vaginal discharge.

Bullet Adenomyosis: Adenomyosis is a condition where the inner lining of the uterus is excessively thick and invades into the muscle layer. Symptoms include heavy and irregular bleeding, lower abdominal pain, pain during intercourse and bleeding in between periods.

Bullet Dysfunctional Uterine Bleeding: Dysfunctional uterine bleeding is an abnormal bleeding that is not due to any obvious cause. Symptoms may include absent periods, irregular periods, or heavy and painful menstrual periods.

Bullet Pregnancy-related Complications: In a woman complaining of heavy bleeding, it may be necessary to check for undetected pregnancy and rule out any pregnancy-related complications like miscarriage.

Bullet Trauma: Trauma to the uterus, cervix and vagina could result in excessive bleeding, that may be mistaken for menstruation. These patients should also be evaluated for possible sexual abuse.

Bullet Cancers: Cancer affecting the uterus may cause symptoms like heavy and irregular menstrual periods, bleeding after menopause, vaginal discharge, lower abdominal and back pain, fatigue and weight loss.

Bullet Endometriosis: Endometriosis is a condition where the tissue lining the uterus is found in parts outside its normal position. The tissue lining the uterus is normally shed during menstruation. Thus, the abnormally positioned tissue also bleeds during menstruation giving rise to symptoms like pain in the abdomen and lower back, heavy vaginal bleeding, painful and prolonged menstrual periods, and pain during intercourse.

Bullet Ovarian Cysts: Ovarian cysts are fluid-filled sacs present in the ovaries. Symptoms include lower back, abdominal or pelvic pain that may worsen during intercourse. Other symptoms include painful, heavy and irregular menstrual periods. In many cases, ovarian cysts resolve without treatment.

Bullet Copper Intrauterine Device: Contraceptive devices placed in the uterus like Copper-T can cause heavy or irregular bleeding in some women. The device may have to be removed in such cases and replaced by another contraceptive.

Conditions Affecting the Body as a Whole:

Bullet Bleeding and Clotting Disorders: A bleeding disorder like Von Willebrandsís disease results in excessive bleeding during menstruation. Anticoagulants or blood thinners also may cause increased bleeding. The patient may also show the presence of other features like excessive bruising, repeated nosebleeds, bleeding gums, rectal bleeding and black stools. A patient with a low platelet count may also show similar symptoms.

Bullet Thyroid Hormone Abnormalities: Hypothyroidism or low thyroid hormone levels can cause excessive bleeding. Thus, a thyroid profile testing may be necessary in women with excessive bleeding.

Bullet Chronic Liver Disease: The liver produces various proteins necessary for clotting. Hence, chronic liver disease may be associated with excessive bleeding during menstruation.

Bullet Polycystic Ovarian Syndrome: A woman with polycystic ovarian syndrome has hormonal imbalances. Besides having cysts in the ovaries, the woman also has irregular periods which may be light or heavy, excessive hair over the body and acne.

Bullet Progesterone-only Contraceptives: Use of contraceptives that contain only progesterone give rise to irregular and sometimes heavy bleeding.

Unknown Causes: In some cases, despite repeated tests, the exact cause for menstrual irregularity cannot be pinpointed.


1. Which doctor should I visit in case I suffer from heavy bleeding?

You should visit a gynecologist in case you suffer from heavy bleeding.

2. What is the normal duration of a menstrual cycle?

A normal menstrual cycle lasts between 21 to 35 days with 3 to 10 days of bleeding. The average amount of menstrual fluid lost is around 30 to 40 mL per cycle.

3. What are the different types of menstrual disorders that a woman in the reproductive period may suffer from?

Some of the menstrual disorders that affect women in the reproductive age group are:

Bullet Amenorrhea: Absent bleeding for a minimum of 6 months

Bullet Oligomenorrhea: Bleeding occurs at intervals of more than 35 days

Bullet Polymenorrhea: Bleeding occurs at intervals of less than 21 days

Bullet Menorrhagia: Heavy bleeding of more than 80 mL per cycle or for more than 7 days

Bullet Metrorrhagia: Irregular bleeding

Bullet Menometrorrhagia: Irregular, heavy and prolonged bleeding

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Great post!!!
ChristopherMitchell Wednesday, March 16, 2016
I have been having periods for the past month and pain similar to period pain. I didn't go on my period last month. My period is heavy and smells foul it's worse if I applied tampons. Please help. Do I have cancer
Sonto86 Wednesday, December 18, 2013
i have been having 20 day cycles from Jan 2013 to April 2013. i did not have periods in May and June. I have restarted the 20 day cycle from July. August has been the same. I am 47, married with a daughter in college. my bleeding is not excessive and there is no pain. I have been treated with hormone tablets and injections for most of last year for the same reason. I do not want any more hormones. is this perimenopause?
sunnyta Tuesday, August 20, 2013

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