Definition

Hypermenorrhea, also known as menorrhagia, is a menstrual disorder characterized by heavy and prolonged bleeding that exceeds the normal menstrual cycle duration. This condition can prevent you from carrying out daily activities due to excessive blood loss and severe cramps.

In hypermenorrhea, menstruation can last for more than 7 days, and you may lose more blood than in a normal menstrual cycle. You may need to change your sanitary pad or tampon every hour because of excessive menstrual bleeding. Additionally, large blood clots can also be passed.

This condition is relatively common, affecting about 27–54% of menstruating women. Severe hypermenorrhea can lead to anemia due to significant blood loss, which can be serious and pose health risks if the anemia is not properly managed.

Causes

Heavy menstrual bleeding can be caused by various factors, including uterine disorders, hormonal imbalances, and even stress.

Hormonal Imbalance

Estrogen and progesterone, the hormones produced by the female body, regulate the menstrual cycle. A hormonal imbalance can cause menstrual disorders like hypermenorrhea, where the uterine tissue (endometrium) grows excessively, leading to heavy menstrual bleeding.

Some conditions that can cause hormonal imbalance include:

• Polycystic ovary syndrome (PCOS)
• Thyroid disorders
• Failure to release an egg from the ovary during the menstrual cycle
• Overweight or obesity

Benign Uterine Tumors and Reproductive Organ Cancers

The growth of benign tumors or lumps in the uterus can also cause hypermenorrhea. Examples of benign conditions that can lead to hypermenorrhea include

• Uterine fibroids: benign tumors in the muscle and connective tissue of the uterus.
• Uterine polyps: small growths on the uterine lining.
• Adenomyosis: a condition where the endometrial tissue starts growing into the uterine muscle.

Cancer in the uterus and cervix (cervical cancer) can cause excessive menstrual bleeding. Endometrial hyperplasia, a thickening of the endometrial tissue in the uterus, can also increase the risk of developing cancer.

Infections

Pelvic infections and sexually transmitted infections can cause hypermenorrhea. Examples include trichomoniasis, gonorrhea, chlamydia, and chronic endometritis (inflammation of the uterine lining).

Pregnancy Complications

During pregnancy, hypermenorrhea can be a warning sign of conditions such as miscarriage or ectopic pregnancy. Bleeding due to a cesarean section can also cause hypermenorrhea.

Other Medical Conditions

Blood clotting disorders and other medical conditions can lead to hypermenorrhea, such as:

• Von Willebrand disease
• Liver disorders
• Kidney disease
• Leukemia (rare)

Medication Effects

Blood anticoagulants, breast cancer medications, contraceptives such as IUDs, contraceptive injections, and birth control pills can cause hypermenorrhea.

Risk Factor

Factors that can increase the risk of hypermenorrhea include:

• Being underweight or having a body mass index outside the normal range
• Smoking
• Severe stress
• History of excessive exercise
• Multiple pregnancies

We also have an article about hypermenorrhoea caused by spiral birth control. You can read the article here: IUD-Induced Menorrhagia - Definition, Cause And Risk Factor.

Symptoms

As mentioned above, you may suspect that your menstrual cycle is heavy and longer than normal if:

• You need to change your sanitary pad or tampon every 1 to 2 hours due to leaking or saturation
• You need to use two sanitary pads or tampons
• Menstrual bleeding lasts more than 7 days
• Large blood clots are expelled
• Daily activities become limited due to heavy bleeding
• Symptoms of anemia, such as fatigue and shortness of breath, are present

Symptoms of hypermenorrhea can resemble other conditions or medical problems. Always consult your doctor to accurately diagnose your condition.

You can read about the menstrual pain article here: Dysmenorrhea - Definition, Cause And Risk Factor

Diagnosis

To diagnose hypermenorrhea, doctors will conduct a medical interview, physical examination, and additional diagnostic tests.

Medical Interview

The doctor will ask about your symptoms and gather information about your current and past menstrual cycles. They may also inquire about:

• Pregnancy history
• Use of contraceptives
• Current or past medications
• Past medical history
• Lifestyle and daily activities
• Family medical history

Physical Examination

The doctor will then perform a physical examination, starting with a general examination to check vital signs like blood pressure, pulse, respiratory rate, and body temperature. This assessment determines whether the patient is stable or needs emergency care.

For sexually active women, a speculum examination may be performed to view the vagina and cervix. This examination helps identify any factors contributing to excessive vaginal bleeding.

Additional Diagnostic Tests

Common tests to diagnose hypermenorrhea include:

• Blood tests: To check red blood cell levels and detect any blood clotting disorders
• Imaging tests: Ultrasound
• Biopsy: Taking a sample from the uterine wall
• Hysteroscopy: To examine the cervix and inner uterus
• Pap smear: To check for cellular changes in the cervix that could indicate cervical cancer

Management

The treatment for hypermenorrhea depends on the cause, the severity of the condition, the patient's age, and overall health. If the patient's condition is unstable, the doctor may administer intravenous fluids or blood transfusions if significant blood loss occurs. Following stabilization, the doctor may prescribe iron supplements for patients with anemia.

Possible treatments for hormonal issues include:

• Pain relief medications, such as ibuprofen or acetaminophen
• Birth control pills to regulate menstrual cycles and reduce excessive bleeding
• Removal of an IUD if it causes hypermenorrhea
• Hormone therapy, which should be carefully considered due to potential risks

Treatment options for hypermenorrhea caused by uterine wall issues include:

• Dilation and curettage (D&C): a procedure that involves scraping the uterine lining to reduce menstrual bleeding.
• Endometrial ablation: a procedure to destroy the uterine wall or endometrium.
• Endometrial resection: removing the endometrium layer; pregnancy is not recommended after this procedure.

Complications

Hypermenorrhea can lead to various complications. Heavy menstrual bleeding can cause iron-deficiency anemia, resulting in a loss of red blood cells and iron. Anemia can impair concentration and cognitive function and, in severe cases, disrupt the functioning of organs.

Additionally, excessive bleeding and uterine contractions can cause severe cramps and abdominal pain, significantly impacting a patient's daily activities and causing stress.

Prevention

You cannot prevent all causes of hypermenorrhea, but you can regularly consult with a gynecologist. You can also educate yourself about normal menstrual cycles and bleeding.

When to See a Doctor?

You should see a doctor if you notice changes in your menstrual cycle and the amount of bleeding. Consult with a gynecologist to determine the cause of your condition. Remember, in addition to pregnancy care, obstetricians and gynecologists are also qualified to handle all diseases related to female reproductive organs.

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