What Is the Most Common Cause Of Menorrhagia?

Menorrhagia is defined as abnormally heavy or prolonged bleeding during the menstrual cycle. Many women experience heavy bleeding during their periods, and a lot of them don’t realize that this amount of bleeding is not normal because it has been going on for a long time.

Women who experience menorrhagia symptoms are often unable to function and carry out their usual activities during their menstrual cycles due to the immense amount and unpredictability of bleeding, as well as, the pain and cramping that often accompany this bleeding.

The Symptoms Of Menorrhagia

If you are experiencing the following, you should contact your doctor to determine the cause.

  • Requiring one or more tampons or sanitary pads every hour for several hours.
  • Having to double up on sanitary pads or use both a pad and a tampon to control the flow of bleeding.
  • Requiring middle-of-the-night sanitary protection changes.
  • Heavy bleeding for a week or longer.
  • Passing blood clots that are the size of a quarter or larger.
  • Your daily activities are restricted due to heavy blood flow and cramping.
  • Exhibiting symptoms such as significant fatigue, lightheadedness, dizziness, migraine-like headaches, chewing, and craving ice.

What Causes Menorrhagia?

The causes of heavy bleeding are commonly divided into two categories: those that are due to a structural cause (e.g. fibroids, polyp) and those that are due to a non-structural cause (e.g. hormonal imbalance, thyroid condition, ovulatory disorder).

Some Conditions that Can Cause Menorrhagia

Uterine Fibroids
Uterine fibroids are by far the most common cause of menorrhagia. They are non-cancerous tumors that grow in the uterus. These growths affect about 70% of all women during their childbearing years; particularly women of color. They can grow very large and create a number of painful debilitating symptoms including heavy prolonged bleeding.
Hormonal Imbalances
Estrogen and progesterone create a balance that regulates the building up and shedding of the uterine lining resulting in the menstrual cycle. If these hormones become unbalanced, abnormalities in this lining (endometrium) can occur and cause the lining to become extra thick and when menstruation occurs, it can result in abnormally heavy bleeding.

Conditions such as PCOS (polycystic ovary syndrome), insulin resistance, thyroid problems, and obesity can all contribute to the imbalance of hormones.

Ovarian Dysfunction
If during the menstrual cycle, the ovary fails to release an egg, it can suppress the production of the hormone progesterone which creates a hormone imbalance and can lead to menorrhagia.
Polyps
Uterine polyps are usually benign and are caused by an overgrowth of the endometrial cells on the lining of the uterus. They can cause unpredictable menstrual cycles with heavy and prolonged bleeding.
Adenomyosis
Adenomyosis is a condition that is often referred to as endometriosis of the uterus because both conditions are caused by the same rogue endometrial cells. If these lining cells end up outside of the uterus, then it is endometriosis. However, if these same cells infiltrate the muscle of the uterus it is called adenomyosis. Adenomyosis causes heavy bleeding just like fibroids and can last much longer than a normal period.
IUD
Intrauterine devices used for birth control can be a cause of menorrhagia. Patients that experience this well-known side effect of an IUD can work with their doctor to find an alternate form of birth control.
Cancer
Cervical and Uterine cancer can cause abnormal and excessive bleeding which is typically seen in postmenopausal women.
Medications
Hormonal medications that contain estrogen, progestins, and anticoagulants like warfarin or enoxaparin can promote prolonged and heavy bleeding during periods.
Rare Inherited Bleeding Disorders
Some conditions such as von Willebrand’s disease can cause abnormal menstrual bleeding.
Complications Of Pregnancy
Sometimes a single, late menstrual cycle that contains unusually heavy bleeding may be due to a miscarriage. Other pregnancy complications such as placenta previa or a low-lying placenta can cause heavy bleeding.
Liver and Kidney Issues
In some cases, diseases of the liver or kidneys have been associated with menorrhagia.
Uterine Fibroid Embolization in Atlanta, GA

Menorrhagia Treatments

The first step in treating menorrhagia is to recognize that the amount of bleeding is abnormal. Next, the focus is on determining the cause of this bleeding. If it is determined that the cause of the heavy bleeding is fibroids, medications are often the first treatment option.

Medications to Treat Menorrhagia

  • NSAIDs (Nonsteroidal anti-inflammatory drugs) such as ibuprofen or naproxen sodium may help reduce heavy menstrual bleeding.
  • Tranexamic acid taken at the time of a period can often help reduce menstrual blood loss.
  • Oral contraceptives can often help regulate a woman’s cycle and reduce heavy or prolonged menstrual bleeding.
  • Sometimes, doctors prescribe hormone therapy using progesterone to help balance hormone levels and reduce menorrhagia.
  • An IUD that releases levonorgestrel, a type of progesterone that thins the uterine lining, can decrease menstrual flow and reduce uterine cramping.

Procedures For Menorrhagia

1. Dilation and Curettage (D&C)
The inside of the uterus is scraped and excess tissue is suctioned from the inside of the uterus to reduce heavy menstrual bleeding. This procedure attempts to “reset” the uterine lining and may alleviate active bleeding from a nonstructural cause (e.g. ovarian dysfunction, hormonal imbalance, bleeding disorder), but often does not correct the root cause of the menorrhagia.
2. Uterine Artery Embolization (UFE)
This non-surgical, outpatient procedure cuts off the blood supply to all of the fibroids present in the uterus. Without a blood supply, the fibroids will die. This causes significant softening and shrinking of these fibroids which leads to symptom relief. It can treat all fibroids no matter their size, location, or how deeply embedded.

It has a long track record (over 25 years) of safety and efficacy (90%) and was endorsed by the American College of Obstetricians and Gynecologists over 15 years ago. Compared to surgery, UFE is much safer, much less invasive (patients are discharged several hours after the procedure with just a bandaid), has a much shorter recovery (5-7 days vs. 6-8 weeks or more), allows women to keep their uterus and even consider having children afterward.

3. Endometrial Ablation
This procedure’s goal is to destroy the lining of the uterus through the application of some form of energy that delivers heat or extreme cold.

This procedure should be reserved for women who are not interested in future fertility AND do not have a structural cause for their heavy bleeding (most notably fibroids and adenomyosis). Read more about why endometrial ablation is not a treatment for fibroids.

PALM-COEIN classification : causes of abnormal vaginal bleeding

While women with fibroids have undergone ablation, this does not address the root cause of the heavy bleeding (i.e. the fibroid itself). Also, these women usually also have bulk-related symptoms (e.g. pelvic pain, and increased urinary frequency).

In addition, if women with adenomyosis undergo ablation, this will typically make their bleeding worse.

4. Myomectomy Surgery
This surgery removes uterine fibroids surgically. This is most commonly performed as an open (i.e long surgical incision) procedure, less commonly using laparoscopy.

Myomectomy suffers from the fact that typically there are many more fibroids left behind after the surgery is done. These fibroids will immediately start to grow and often lead to a recurrence of symptoms; typically within 5 years of the surgery (11% per year rate of recurrence).

Due to the surgical cutting of the uterus, a woman’s fertility diminishes from the scar tissue that forms. In addition, if she is successful in becoming pregnant, any delivery would require a c-section due to fear of uterine rupture. As an aside, pregnancies following Uterine Fibroid Embolization (UFE) are typically full-term and vaginal.

5. Hysterectomy
This surgery permanently removes a woman’s uterus, prevents future fertility, and often causes the early onset of menopause (even when the ovaries remain). While a hysterectomy will stop menorrhagia, many women also experience adverse long-term side effects after a hysterectomy. Which are often worse than the original heavy bleeding (e.g. sexual dysfunction, urinary leaking, and psychological changes similar to male castration). Therefore, hysterectomy should be relegated to a last resort option; particularly given the success of the nonsurgical UFE procedure.
6. MRI-guided Focused Ultrasound (MRI-guided FUS)
This procedure treats bleeding caused by fibroids by directing ultrasonic energy to a point (the size of a grain of rice) within a fibroid to prompt tissue necrosis.

This technology is exciting due to its noninvasive approach. However, the procedure can only be performed on a very small set of fibroid patients as it obviously limited due to the time constraints of this tiny point-by-point treatment. It can work for patients with a single fibroid determined to be the cause of their symptoms. Most women however have numerous fibroids; many of which are inaccessible due to their size or location near critical structures that cannot be near the “burn zone”.

MRI-guided FUS also relies on the complete destruction of the fibroid and a number of studies showed that there was a portion of the fibroid that was not destroyed. Over time, this living portion of the fibroid grew back to fill in the treated area and led to a complete recurrence of symptoms.

Also, the procedure is also not covered by the vast majority of insurance companies and is an expensive out-of-pocket procedure.

If you are experiencing heavy prolonged bleeding during your menstrual cycle, you may have fibroids. A visit to your OB-Gyn can help determine if fibroids are present and an MRI can clearly identify their types, sizes, and locations.

Uterine fibroid embolization can help eliminate fibroids and the debilitating symptoms they can cause. Contact The Atlanta Fibroid Center and set up a consultation today to learn more about UFE and how it can help you become fibroid free without surgery!

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