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Menorrhagia is the medical term for menstrual periods with abnormally heavy or prolonged bleeding. Although heavy menstrual bleeding is a common concern, most women don’t experience blood loss severe enough to be defined as menorrhagia.

With menorrhagia, you can’t maintain your usual activities when you have your period because you have so much blood loss and cramping. If you dread your period because you have such heavy menstrual bleeding, talk with your doctor. There are many effective treatments for menorrhagia.

Symptoms of Menorrhagia

Signs and symptoms of menorrhagia may include:

Soaking through one or more sanitary pads or tampons every hour for several consecutive hours

Needing to use double sanitary protection to control your menstrual flow

Needing to wake up to change sanitary protection during the night

Bleeding for longer than a week

Passing blood clots larger than a quarter

Symptoms of anemia, such as tiredness, fatigue or shortness of breath

When to see a doctor

Seek medical help before your next scheduled exam if you experience:

Vaginal bleeding so heavy it soaks at least one pad or tampon an hour for more than two hours

Bleeding between periods or irregular vaginal bleeding

Any vaginal bleeding after menopause

Causes of Menorrhagia

In some cases, the cause of heavy menstrual bleeding is unknown, but a number of conditions may cause menorrhagia. Common causes include:

Hormone imbalance. In a normal menstrual cycle, a balance between the hormones estrogen and progesterone regulates the buildup of the lining of the uterus (endometrium), which is shed during menstruation. If a hormone imbalance occurs, the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding.

A number of conditions can cause hormone imbalances, including polycystic ovary syndrome (PCOS), obesity, insulin resistance and thyroid problems.

Dysfunction of the ovaries. If your ovaries don’t release an egg (ovulate) during a menstrual cycle (anovulation), your body doesn’t produce the hormone progesterone, as it would during a normal menstrual cycle. This leads to hormone imbalance and may result in menorrhagia.

Uterine fibroids. These noncancerous (benign) tumors of the uterus appear during your childbearing years. Uterine fibroids may cause heavier than normal or prolonged menstrual bleeding.

Polyps. Small, benign growths on the lining of the uterus (uterine polyps) may cause heavy or prolonged menstrual bleeding.

Adenomyosis. This condition occurs when glands from the endometrium become embedded in the uterine muscle, often causing heavy bleeding and painful periods.

Intrauterine device (IUD). Menorrhagia is a well-known side effect of using a nonhormonal intrauterine device for birth control. Your doctor will help you plan for alternative management options.

Pregnancy complications. A single, heavy, late period may be due to a miscarriage. Another cause of heavy bleeding during pregnancy includes an unusual location of the placenta, such as a low-lying placenta or placenta previa.

Cancer. Uterine cancer and cervical cancer can cause excessive menstrual bleeding, especially if you are postmenopausal or have had an abnormal Pap test in the past.

Inherited bleeding disorders. Some bleeding disorders — such as von Willebrand’s disease, a condition in which an important blood-clotting factor is deficient or impaired — can cause abnormal menstrual bleeding.

Medications. Certain medications, including anti-inflammatory medications, hormonal medications such as estrogen and progestins, and anticoagulants such as warfarin (Coumadin, Jantoven) or enoxaparin (Lovenox), can contribute to heavy or prolonged menstrual bleeding.

Other medical conditions. A number of other medical conditions, including liver or kidney disease, may be associated with menorrhagia.

Risk factors

Risk factors vary with age and whether you have other medical conditions that may explain your menorrhagia. In a normal cycle, the release of an egg from the ovaries stimulates the body’s production of progesterone, the female hormone most responsible for keeping periods regular. When no egg is released, insufficient progesterone can cause heavy menstrual bleeding.

Menorrhagia in adolescent girls is typically due to anovulation. Adolescent girls are especially prone to anovulatory cycles in the first year after their first menstrual period (menarche).

Menorrhagia in older reproductive-age women is typically due to uterine pathology, including fibroids, polyps and adenomyosis. However, other problems, such as uterine cancer, bleeding disorders, medication side effects and liver or kidney disease could be contributing factors.

Complications

Excessive or prolonged menstrual bleeding can lead to other medical conditions, including:

Anemia. Menorrhagia can cause blood loss anemia by reducing the number of circulating red blood cells. The number of circulating red blood cells is measured by hemoglobin, a protein that enables red blood cells to carry oxygen to tissues.

Iron deficiency anemia occurs as your body attempts to make up for the lost red blood cells by using your iron stores to make more hemoglobin, which can then carry oxygen on red blood cells. Menorrhagia may decrease iron levels enough to increase the risk of iron deficiency anemia.

Signs and symptoms include pale skin, weakness and fatigue. Although diet plays a role in iron deficiency anemia, the problem is complicated by heavy menstrual periods.

Severe pain. Along with heavy menstrual bleeding, you might have painful menstrual cramps (dysmenorrhea). Sometimes the cramps associated with menorrhagia are severe enough to require medical evaluation.

Treatment of Menorrhagia

Specific treatment for menorrhagia is based on a number of factors, including:

Your overall health and medical history

The cause and severity of the condition

Your tolerance for specific medications, procedures or therapies

The likelihood that your periods will become less heavy soon

Your future childbearing plans

Effects of the condition on your lifestyle

Your opinion or personal preference

Medications

Medical therapy for menorrhagia may include:

Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), help reduce menstrual blood loss. NSAIDs have the added benefit of relieving painful menstrual cramps (dysmenorrhea).

Tranexamic acid. Tranexamic acid (Lysteda) helps reduce menstrual blood loss and only needs to be taken at the time of the bleeding.

Oral contraceptives. Aside from providing birth control, oral contraceptives can help regulate menstrual cycles and reduce episodes of excessive or prolonged menstrual bleeding.

Oral progesterone. The hormone progesterone can help correct hormone imbalance and reduce menorrhagia.

Hormonal IUD (Liletta, Mirena). This intrauterine device releases a type of progestin called levonorgestrel, which makes the uterine lining thin and decreases menstrual blood flow and cramping.

If you have menorrhagia from taking hormone medication, you and your doctor may be able to treat the condition by changing or stopping your medication.

If you also have anemia due to your menorrhagia, your doctor may recommend that you take iron supplements regularly. If your iron levels are low but you’re not yet anemic, you may be started on iron supplements rather than waiting until you become anemic.

Understanding your epilepsy condition can help you take better control of it. And to the people who stay with the affected indviduals, giving them care and support in their time of need is always the best therapy.

Lifestyle and Home Remedies for Epilepsy

Take your medication correctly. Don’t adjust your dosage before talking to your doctor. If you feel your medication should be changed, discuss it with your doctor.

Get enough sleep. Lack of sleep can trigger seizures. Be sure to get adequate rest every night.

Wear a medical alert bracelet. This will help emergency personnel know how to treat you correctly.

Exercise. Exercising may help keep you physically healthy and reduce depression. Make sure to drink enough water, and rest if you get tired during exercise.

In addition, make healthy life choices, such as managing stress, limiting alcoholic beverages and avoiding cigarettes.

Coping and support

Uncontrolled seizures and their effects on your life may at times feel overwhelming or lead to depression. It’s important not to let epilepsy hold you back. You can still live an active, full life. To help cope:

Educate yourself and your friends and family about epilepsy so that they understand the condition.

Try to ignore negative reactions from people. It helps to learn about epilepsy so that you know the facts as opposed to misconceptions about the disease. And try to keep your sense of humor.

Live as independently as possible. Continue to work, if possible. If you can’t drive because of your seizures, investigate public transportation options near you. If you aren’t allowed to drive, you might consider moving to a city with good public transportation options.

Find a doctor you like and with whom you feel comfortable.

Try not to constantly worry about having a seizure.

Find an epilepsy support group to meet people who understand what you’re going through.

If your seizures are so severe that you can’t work outside your home, there are still ways to feel productive and connected to people. You may consider working from home.

Let people you work and live with know the correct way to handle a seizure in case they are with you when you have one.

You may offer them suggestions, such as:

Carefully roll the person onto one side to prevent choking.

Place something soft under his or her head.

Loosen tight neckwear.

Don’t try to put your fingers or anything else in the person’s mouth. No one has ever “swallowed” his or her tongue during a seizure — it’s physically impossible.

Don’t try to restrain someone having a seizure.

If the person is moving, clear away dangerous objects.

Stay with the person until medical personnel arrive.

Observe the person closely so that you can provide details on what happened.

Time the seizures. Be calm during the seizures.

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DIAGNOSIS and TREATMENT of EPILEPSY

To diagnose your condition, your doctor will review your symptoms and medical history. Your doctor may order several tests to diagnose epilepsy and determine the cause of seizures.

Your evaluation for Epilepsy includes:

A neurological exam. Your doctor may test your behavior, motor abilities, mental function and other areas to diagnose your condition and determine the type of epilepsy you may have.

Blood tests. Your doctor may take a blood sample to check for signs of infections, genetic conditions or other conditions that may be associated with seizures.

Your doctor may also suggest tests to detect brain abnormalities, such as:

Electroencephalogram (EEG). This is the most common test used to diagnose epilepsy. In this test, electrodes are attached to your scalp with a paste-like substance or cap. The electrodes record the electrical activity of your brain.

If you have epilepsy, it’s common to have changes in your normal pattern of brain waves, even when you’re not having a seizure. Your doctor may monitor you on video when conducting an EEG while you’re awake or asleep, to record any seizures you experience. Recording the seizures may help the doctor determine what kind of seizures you’re having or rule out other conditions.

The test may be done in a doctor’s office or the hospital. If appropriate, you may also have an ambulatory EEG, which you wear at home while the EEG records seizure activity over the course of a few days.

Your doctor may give you instructions to do something that will cause seizures, such as getting little sleep prior to the test.

High-density EEG. In a variation of an EEG test, your doctor may recommend high-density EEG, which spaces electrodes more closely than conventional EEG — about a half a centimeter apart. High-density EEG may help your doctor more precisely determine which areas of your brain are affected by seizures.

Computerized tomography (CT) scan. A CT scan uses X-rays to obtain cross-sectional images of your brain. CT scans can reveal abnormalities in the structure of your brain that might be causing your seizures, such as tumors, bleeding and cysts.

Magnetic resonance imaging (MRI). An MRI uses powerful magnets and radio waves to create a detailed view of your brain. Your doctor may be able to detect lesions or abnormalities in your brain that could be causing your seizures.

Functional MRI (fMRI). A functional MRI measures the changes in blood flow that occur when specific parts of your brain are working. Doctors may use an fMRI before surgery to identify the exact locations of critical functions, such as speech and movement, so that surgeons can avoid injuring those places while operating.

Positron emission tomography (PET). PET scans use a small amount of low-dose radioactive material that’s injected into a vein to help visualize metabolic activity of the brain and detect abnormalities. Areas of the brain with low metabolism may indicate where seizures occur.

Single-photon emission computerized tomography (SPECT). This type of test is used primarily if you’ve had an MRI and EEG that didn’t pinpoint the location in your brain where the seizures are originating.

A SPECT test uses a small amount of low-dose radioactive material that’s injected into a vein to create a detailed, 3D map of the blood flow activity in your brain during seizures. Areas of higher than normal blood flow during a seizure may indicate where seizures occur.

Doctors may also conduct a form of a SPECT test called subtraction ictal SPECT coregistered to MRI (SISCOM), which may provide even more-detailed results by overlapping the SPECT results with a patient’s brain MRI.

Neuropsychological tests. In these tests, doctors assess your thinking, memory and speech skills. The test results help doctors determine which areas of your brain are affected.

Along with your test results, your doctor may use a combination of analysis techniques to help pinpoint where in the brain seizures start:

Statistical parametric mapping (SPM). SPM is a method of comparing areas of the brain that have increased blood flow during seizures to normal brains, which can give doctors an idea of where seizures begin.

Electrical source imaging (ESI). ESI is a technique that takes EEG data and projects it onto an MRI of the brain to show doctors where seizures are occurring.

Magnetoencephalography (MEG). MEG measures the magnetic fields produced by brain activity to identify potential areas of seizure onset.

Accurate diagnosis of your seizure type and where seizures begin gives you the best chance for finding an effective treatment.

Treatment Of Epilepsy

Doctors generally begin by treating epilepsy with medication. If medications don’t treat the condition, doctors may propose surgery or another type of treatment.

Medication

Most people with epilepsy can become seizure-free by taking one anti-seizure medication, which is also called anti-epileptic medication. Others may be able to decrease the frequency and intensity of their seizures by taking a combination of medications.

Many children with epilepsy who aren’t experiencing epilepsy symptoms can eventually discontinue medications and live a seizure-free life. Many adults can discontinue medications after two or more years without seizures. Your doctor will advise you about the appropriate time to stop taking medications.

Finding the right medication and dosage can be complex. Your doctor will consider your condition, frequency of seizures, your age and other factors when choosing which medication to prescribe. Your doctor will also review any other medications you may be taking, to ensure the anti-epileptic medications won’t interact with them.

Your doctor likely will first prescribe a single medication at a relatively low dosage and may increase the dosage gradually until your seizures are well controlled.

There are more than 20 different types of anti-seizure medications available. The medication that your doctor chooses to treat your epilepsy depends on the type of seizures you have, as well as other factors such as your age and other health conditions.

These medications may have some side effects. Mild side effects include:

Dizziness and Fatigue

Weight gain

Loss of bone density

Skin rashes

Loss of coordination

Speech problems

Memory and thinking problems

More-severe but rare side effects include:

Depression

Suicidal thoughts and behaviors

Severe rash

Inflammation of certain organs, such as your liver

To achieve the best seizure control possible with medication, follow these steps:

Take medications exactly as prescribed.

Always call your doctor before switching to a generic version of your medication or taking other prescription medications, over-the-counter drugs or herbal remedies.

Never stop taking your medication without talking to your doctor.

Notify your doctor immediately if you notice new or increased feelings of depression, suicidal thoughts, or unusual changes in your mood or behaviors.

Tell your doctor if you have migraines. Doctors may prescribe one of the anti-epileptic medications that can prevent your migraines and treat epilepsy.

At least half the people newly diagnosed with epilepsy will become seizure-free with their first medication. If anti-epileptic medications don’t provide satisfactory results, your doctor may suggest surgery or other therapies.

You’ll have regular follow-up appointments with your doctor to evaluate your condition and medications.

When medications fail to provide adequate control over seizures, surgery may be an option. With epilepsy surgery, a surgeon removes the area of your brain that’s causing seizures.