Heavy menstrual bleeding is defined as blood loss greater than about 80 milliliters each cycle. Since it can be difficult to measure volume of menstrual blood loss, an easier indicator for doctors is the frequency at which a woman changes her sanitary pads or tampons, as well as menstrual clotting — especially clots larger than 1 inch in diameter.

The need to continuously change sanitary protection can impact quality of life and trigger stress. Heavy menstrual bleeding can make it difficult for some women to carry out day-to-day responsibilities. More importantly, menorrhagia may be a symptom of a more serious condition.

Heavy menstrual bleeding may be caused by a variety of underlying physical issues. One major cause of menorrhagia has to do with hormones.

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Hormones are the great conductors of the menstrual cycle. The female hormones estrogen and progesterone help prepare a woman’s body for a possible pregnancy by thickening the uterine lining, called the endometrium. If the released egg isn’t fertilized, hormone levels will go down and the body will shed the endometrium, producing the bleeding known as the menstrual period.

Why do women have periods?

Changes in hormone levels (especially for teenage girls), the approach of menopause, and using certain types of birth control can all trigger abnormal bleeding. Too much or too little of a specific type of hormone may also be due to certain medications or thyroid problems.

Possible causes of abnormal or heavy menstrual bleeding include:

Endometrial polyps

Polyps (fleshy lumps) can grow in the lining of the womb (endometrium) and become more common from the mid-thirties onwards. They are mostly benign (non-cancerous).

Uterine fibroids

Uterine fibroids are benign muscle tumours that grow in the wall of the womb and cause it to be enlarged.

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 Adenomyosis

Adenomyosis is a condition where the womb lining (endometrium) becomes embedded deeper into the wall of the womb than it should be. The womb becomes enlarged and often painful.

Cancer

Cancers that occur in the lining of the womb (endometrial cancer), the wall of the womb (leiomyosarcoma), neck of the womb (cervical cancer), or the ovaries (ovarian cancer) may all cause irregular bleeding. Persistent abnormal bleeding, or any bleeding after the menopause, should be investigated by a gynecologist.

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