Menorrhagia

Menorrhagia, or heavy menstrual bleeding, refers to menstrual bleeding that is excessive in volume or duration and interferes with a person’s physical, emotional, social, or work life. It is often defined clinically as blood loss exceeding about 80 mL per cycle or bleeding lasting more than seven days, though patient-reported impact is also an important criterion.

Causes of menorrhagia are diverse and may be structural, hormonal, or related to bleeding disorders. Structural uterine conditions include fibroids, adenomyosis, and endometrial polyps. Endometrial disorders such as hyperplasia or, in older individuals, malignancy can contribute. Anovulatory cycles, common in adolescence and perimenopause, due to hormonal imbalance can lead to irregular, prolonged shedding. Coagulopathies (for example von Willebrand disease) and platelet function disorders increase menstrual blood loss. Medications such as anticoagulants or antiplatelet agents, as well as intrauterine devices that influence endometrial lining, may play a role. Other risk factors include obesity, thyroid disorders, and certain reproductive or metabolic conditions.

Evaluation typically begins with a detailed history and physical examination, including pregnancy testing to exclude pregnancy-related causes. Laboratory tests may include complete blood count, ferritin or iron studies, thyroid function, and coagulation testing if a bleeding disorder is suspected. Pelvic ultrasound assesses uterine anatomy; MRI may be used for suspected adenomyosis or fibroids. Endometrial sampling is considered for women over 35 or those at risk for endometrial pathology or after failure of medical therapy.

Management aims to reduce bleeding, correct anemia, and address the underlying cause. Treatments include tranexamic acid or NSAIDs during menses, hormonal therapies (combined oral contraceptives, progestins, or levonorgestrel-releasing intrauterine system), and iron supplementation. GnRH agonists may be used as short-term bridge therapy. Surgical options for refractory cases include endometrial ablation or uterine-sparing procedures, or hysterectomy in selected individuals.