What are the symptoms of menorrhagia?

• "Excessive" menstrual flow defined subjectively varies greatly from woman to woman (average normal menstrual flow is about 30-40 mL per cycle) • Useful historical features include: • Bleeding substantially heavier than the patient's usual flow • Bleeding lasting more than 7 days • Flow associated with passage of significant clots • Anemia • The following symptoms tend to suggest that cycles are ovulatory: • Regular menstrual interval • Mid-cycle pain (mittelschmerz) • Dysmenorrhea • Premenstrual symptoms - breast soreness, mood changes, etc.

What causes menorrhagia?

Menorrhagia can be caused by a variety of causes. These include: Imbalance of hormones (estrogen and progesterone), Fibroids (benign uterine tumors), Pelvic infection, Endometrial disorder, Intrauterine device, Hypothyroidism, Pregnancy, Ovarian cyst or tumor and other hormonal causes.

What are the risk factors for menorrhagia?

• Obesity • Anovulation • Estrogen administration (without progestin) • Prior treatment with progestational agents or oral contraceptives increases the risk of endometrial atrophy, but decreases the risk of endometrial hyperplasia or neoplasia

How is menorrhagia diagnosed?

• Pregnancy complications: • Threatened abortion • Incomplete abortion • Ectopic pregnancy • Nonuterine bleeding: • Cervical ectropion/erosion • Cervical neoplasia/polyp • Cervical or vaginal trauma • Condylomata • Atrophic vaginitis • Foreign bodies • Pelvic inflammatory disease (PID): • Endometritis • Tuberculosis

What is the outlook for menorrhagia?

• Varies with cause of bleeding • Most patients with hormonal causes will respond to hormonal manipulation

Guide

Menorrhagia

Andrey Nailor, M.D.Published 20 August 20066 min read

Key points

Menorrhagia is defined as excessive amount or duration of menstrual flow, at more or less regular intervals.
These include: Imbalance of hormones (estrogen and progesterone), Fibroids (benign uterine tumors), Pelvic infection, Endometrial disorder, Intrauterine device, Hypothyroidism, Pregnancy, Ovarian cyst or tumor and other hormonal causes.
Endometrial biopsy detects hyperplasia, dysplasia, or atrophy.
Geriatric: Genital atrophy may predispose to bleeding with minimal trauma.

Description

Excessive amount or duration of menstrual flow, at more or less regular intervals

Menorrhagia is defined as excessive amount or duration of menstrual flow, at more or less regular intervals. Menorrhagia is characterized by unusually heavy menstruation or prolonged menstrual flow. The average amount of blood loss during a normal menstrual period is 40 to 50 ml. With menorrhagia, a woman may lose 80 ml or more. It rarely signifies a serious underlying disorder.

Menorrhagia is distinguished from, but may overlap with, Metrorrhagia (irregular or frequent flow, noncyclic), Menometrorrhagia (frequent, excessive, irregular flow; menorrhagia plus metrorrhagia), Polymenorrhea (frequent flow, cycles of 21 days or less), Intermenstrual bleeding (bleeding between regular menses), and Dysfunctional uterine bleeding - DUB (abnormal endometrial bleeding of hormonal cause and related to anovulation).

Distinguish from, but may overlap with:
- Metrorrhagia - irregular or frequent flow, noncyclic
- Menometrorrhagia - frequent, excessive, irregular flow (menorrhagia plus metrorrhagia)
- Polymenorrhea - frequent flow, cycles of 21 days or less
- Intermenstrual bleeding - bleeding between regular menses
- Dysfunctional uterine bleeding (DUB) - abnormal endometrial bleeding of hormonal cause and related to anovulation

System(s) affected: Reproductive

Incidence/Prevalence in USA: Abnormal bleeding is common; prevalence varies with definition (endometrial carcinoma: about 40,000 new cases per year)

Predominant age

Menarche to menopause; about 50% of cases occur after 40 years of age
Dysfunctional bleeding is fairly common in adolescence and near menopause

Predominant sex: Female only

Menorrhagia - Mesentery, mesenteric

Menorrhagia (primary) 626.2
Menorrhagia, climacteric 627.0
Menorrhagia, menopausal 627.0
Menorrhagia, postclimacteric 627.1
Menorrhagia, postmenopausal 627.1
Menorrhagia, preclimacteric 627.0
Menorrhagia, premenopausal 627.0
Menorrhagia, puberty (menses retained) 626.3

Sings and symptoms

"Excessive" menstrual flow defined subjectively varies greatly from woman to woman (average normal menstrual flow is about 30-40 mL per cycle)

Written and revised by

Andrey Nailor, M.D.

Our doctors write and review articles for accuracy and keep them up to date.

health.am provides general information, not medical advice. Always consult a qualified health professional about your own health.

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Menorrhagia

Andrey Nailor, M.D.Published 20 August 20066 min read