What causes Heavy
Menstrual Bleeding (HMB)?
Heavy periods are common (one out of three women suffer from HMB at one point in their life), but they can have a major impact on a woman's daily life. There are multiple causes for heavy periods like the ones listed below, however in the majority of cases there is no identification of any problem with the uterus itself. Many times, a hormonal condition may be the reason for heavy menstrual bleeding. The good news is that there are options for treatment.
Overview of possible causes of heavy menstrual bleeding, typical diagnosis and treatments
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Definition
Polyps are benign growths on the lining of the uterus
Diagnosis
Polyps are usually diagnosed with ultrasoundiUltrasound (or ultrasonography) is a diagnostic imaging technique based on the application of ultrasound to see internal body structures, such as the womb. and hysteroscopyiHysteroscopy is the visualization of the uterine cavity with a medical instrument that has a camera. It allows for the diagnosis of intrauterine pathology and can also facilitate surgical intervention. (looking at the inside of the uterusiThe uterus or womb, is a female organ located in the pelvis: its lower end opens into the vagina while the upper end is connected to the fallopian tubes. Through the menstrual cycle, in response to hormones, the uterus undergoes changes that can lead to either a period or a pregnancy. In case of pregnancy, it is within the uterus that the fetus develops. through a scope)
Usual treatment
Surgical
Definition
Uterine fibroids are noncancerous (benign) tumors or growths of the uterusiThe uterus or womb, is a female organ located in the pelvis: its lower end opens into the vagina while the upper end is connected to the fallopian tubes. Through the menstrual cycle, in response to hormones, the uterus undergoes changes that can lead to either a period or a pregnancy. In case of pregnancy, it is within the uterus that the fetus develops.
Diagnosis
Uterine fibroids are usually diagnosed by ultrasoundiUltrasound (or ultrasonography) is a diagnostic imaging technique based on the application of ultrasound to see internal body structures, such as the womb.
Usual treatment
Treatment depends on the size and location of the fibroids and can be medical or surgical
Definition
Some inherited bleeding-related disorders — such as von Willebrand's disease, a condition caused by a deficient or impaired important blood-clotting factor, can also cause heavy menstrual bleeding. Women with this type of condition usually bleed excessively (e.g. from the nose or gums) and bruise easily
Diagnosis
Bleeding disorders are diagnosed based on personal and familiar medical history and blood tests
Usual treatment
Medical
Definition
Hormonal imbalance in women is a very common cause of heavy menstrual bleeding. If your ovaries don't release an egg (ovulationiOvulation is the release of eggs from the ovaries. After ovulation, the egg will be available to be fertilized by sperm.) during a menstrual cycle, your body doesn't produce the hormone progesterone, as it would during a ‘normal menstrual’ cycleiThe menstrual cycle is a natural process governed by female hormones. During this regular cycle an egg is released by the ovaries and the womb is prepared for the implantation of the embryo if the egg is fertilized. This leads to a hormone imbalance that can cause excessive buildup of the uterusiThe uterus or womb, is a female organ located in the pelvis: its lower end opens into the vagina while the upper end is connected to the fallopian tubes. Through the menstrual cycle, in response to hormones, the uterus undergoes changes that can lead to either a period or a pregnancy. In case of pregnancy, it is within the uterus that the fetus develops. lining and heavy periods
Diagnosis
Hormonal imbalance is predominantly diagnosed based on your clinical history and following exclusion of pre-existing uterine conditions associated with heavy menstrual bleeding
Usual treatment
Medical
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Definition
Adenomyosis occurs when the lining of the uterusiThe uterus or womb, is a female organ located in the pelvis: its lower end opens into the vagina while the upper end is connected to the fallopian tubes. Through the menstrual cycle, in response to hormones, the uterus undergoes changes that can lead to either a period or a pregnancy. In case of pregnancy, it is within the uterus that the fetus develops. (the endometriumiEndometrium is the tissue lining the inner cavity of the womb. It is influenced by hormones during the menstrual cycle and is shed through the vagina during the period. In case of pregnancy, the endometrium is the place where the embryo implants and starts growing.) grows into the muscular wall of the uterus (the myometriumiMyometrium is the muscular outer layer of the womb, responsible for inducing contractions during labor.)
Diagnosis
Adenomyosis can be diagnosed by ultrasoundiUltrasound (or ultrasonography) is a diagnostic imaging technique based on the application of ultrasound to see internal body structures, such as the womb. or magnetic resonanceiMagnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy of the body by using magnetic fields. imaging
Usual treatment
Treatment is usually medical but some cases may require surgery
Definition
The most common uterine cancers are; endometrial cancer (cancer on the lining of the uterusiThe uterus or womb, is a female organ located in the pelvis: its lower end opens into the vagina while the upper end is connected to the fallopian tubes. Through the menstrual cycle, in response to hormones, the uterus undergoes changes that can lead to either a period or a pregnancy. In case of pregnancy, it is within the uterus that the fetus develops., which is more common in older women; and cervical cancer (cancer in the entrance to the uterus from the vagina), which is more common in younger women
Diagnosis
Uterine cancer is diagnosed using a combination of imaging techniques (like magnetic resonanceiMagnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy of the body by using magnetic fields. and tissue biopsyiA biopsy is a medical test involving extraction of sample cells or tissues for examination (under the microscope) to determine the presence or extent of a disease.
Usual treatment
Treatment depends on the type and size of the tumor and is usually surgical. It often involves chemotherapy and/or radiotherapy
Definition
Heavy menstrual bleeding may also be associated with other medical conditions, including liver, kidney or thyroid disorders
Diagnosis
Kidney, liver and thyroid disorders are diagnosed based on clinical history and blood tests
Usual treatment
Treatment depends on the specific cause, but is usually medical
Definition
Certain medications, including anti-inflammatories, anticoagulants or copper intrauterine devices (IUD) can contribute to heavy or prolonged menstrual bleeding
Diagnosis
Heavy menstrual bleeding due to side effects of medication is diagnosed by the clinical history, after the exclusion of other causes
Usual treatment
Treated by stopping the drug or removing the copper IUD. When patients cannot stop the drug because they need it to treat other health problems, medical treatment can help overcome the heavy menstrual bleeding
Definition
Problems related to pregnancy might be associated with heavy bleeding, such as a miscarriageiMiscarriage, also known as spontaneous abortion, is the natural death of an embryo or fetus before it is able to survive independently. It is more frequent in the beginning of the pregnancy. (when the pregnancy is interrupted at an early stage) or an ectopic pregnancy (when a pregnancy develops outside of the uterusiThe uterus or womb, is a female organ located in the pelvis: its lower end opens into the vagina while the upper end is connected to the fallopian tubes. Through the menstrual cycle, in response to hormones, the uterus undergoes changes that can lead to either a period or a pregnancy. In case of pregnancy, it is within the uterus that the fetus develops., usually in the fallopian tubes)
Diagnosis
A miscarriage is usually diagnosed with ultrasoundiUltrasound (or ultrasonography) is a diagnostic imaging technique based on the application of ultrasound to see internal body structures, such as the womb. and an ectopic pregnancy is diagnosed with a combination of ultrasound and blood tests
Usual treatment
Treatment is usually medical, but surgery may be needed in some cases
In addition to heavy bleeding, additional symptoms might suggest a specific cause, so it’s important you provide your doctor with a detailed explanation of what you feel.
- Hormone-related problems, such as hormonal imbalance, may be associated with symptoms related to hormonal disorders such as acne, excessive body or facial hair and difficulties getting pregnant.
- Conditions of the womb or ovaries are uterine-related problems and often associated with additional symptoms such as, a change in your usual pattern of bleeding, bleeding between periods, bleeding or pain during or just after sex, pelvic pain apart from the usual period pain and vaginal dischargeiVaginal discharge is a mixture of liquid, cells and bacteria that lubricates and protects the vagina. It is produced by the vagina and cervix and exits the body through the vagina. Most discharge represents the normal functioning of the body, however some changes in discharge can reflect infection or other pathological processes..
- Other illnesses or conditions are usually associated with additional symptoms depending on the underlying condition.
Treatment options
You don’t have to put up with heavy periods as just part of ‘being a woman’. Find out about your treatment options.
