What causes Heavy Menstrual Bleeding?
There are multiple causes of heavy menstrual bleeding. 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. The causes of heavy bleeding can be due to:
- Uterine-related problems, for example fibroids, polyps, adenomyosis or cancer, are 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 discharge
- Hormone-related problems, such as hormonal imbalance in women, may be associated with symptoms related to hormonal disorders such as acne, excessive body or facial hair and difficulties getting pregnant.
- Other illnesses or conditions, such as bleeding disorders, medication, pregnancy related issues and other disorders are usually associated with additional symptoms depending on the underlying condition, such as bleeding from the gums and nose.
Uterine fibroids are noncancerous (benign) tumors or growths of the uterus
Uterine fibroids are usually diagnosed by ultrasound
Treatment depends on the size and location of the fibroids and can be medical or surgical
Polyps are benign growths on the lining of the uterus
Polyps are usually diagnosed with ultrasound and hysteroscopy (looking into the uterus with a camera)
Surgical
Adenomyosis occurs when the lining of the uterus (the endometrium) grows into the muscular wall of the uterus (the myometrium)
Adenomyosis can be diagnosed by ultrasound or magnetic resonance
Treatment is usually medical but some cases may require surgery
Hormonal imbalance in women is a very common cause of heavy menstrual bleeding. If your ovaries don't release an egg (ovulation) during a menstrual cycle, your body doesn't produce the hormone progesterone, as it would during a ‘normal menstrual’ cycle . This leads to a hormone imbalance that can cause excessive buildup of the uterus lining and heavy periods
Hormonal imbalance is predominantly diagnosed based on your clinical history and following exclusion of pre-existing uterine conditions associated with heavy menstrual bleeding
Medical
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
Bleeding disorders are diagnosed based on personal and familiar medical history and blood tests
Medical
Heavy menstrual bleeding may also be associated with other medical conditions, including liver, kidney or thyroid disorders
Kidney, liver and thyroid disorders are diagnosed based on clinical history and blood tests
Treatment depends on the specific cause, but is usually medical
Certain medications, including anti-inflammatories (such as aspirin), anticoagulants (such as warfarin or enoxaparin) or copper intrauterine devices (IUD) can contribute to heavy or prolonged menstrual bleeding
Heavy menstrual bleeding due to side effects of medication is diagnosed by the clinical history, after the exclusion of other causes
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
The most common uterine cancers are; endometrial cancer (cancer on the lining of the uterus), 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
Uterine cancer is diagnosed using a combination of imaging techniques (like magnetic resonance) and tissue biopsy
Treatment depends on the type and size of the tumor and is usually surgical. It often involves chemotherapy and/or radiotherapy
Problems related to pregnancy might be associated with heavy bleeding, such as a miscarriage (when the pregnancy is interrupted at an early stage) or an ectopic pregnancy (when a pregnancy develops outside of the uterus , usually in the fallopian tubes)
A miscarriage is usually diagnosed with ultrasound and an ectopic pregnancy is diagnosed with a combination of ultrasound and blood tests
Treatment is usually medical, but surgery may be needed in some cases
