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It is not easy to determine what amount of menstrual bleeding is and is not normal, because menstrual flow varies greatly among women. In some women, periods are irregular and with a small amount of blood, while about five percent of women have constitutionally heavy menstrual periods (menorrhagia). Besides being a normal variation, increased bleeding can be a sign of a disease, especially if bleeding patterns suddenly change.

Signs And Symptoms Of Menorrhagia

The average amount of blood that is evacuated during period is about 60 milliliters. Menorrhagia is diagnosed if the amount is larger than 80 milliliters repeatedly from period to period, although some women have symptoms even with smaller loss of blood.

Women usually first notice that they need to change pads or tampons more often than usual, often even every hour.

When the amount of menstrual blood is increased, the blood gets organized in small or large clumps (clots), which can be seen often in women with menorrhagia. Signs of increased bleeding include nausea, fatigue, thirst, and general feeling of weakness. If this state is prolonged, it can lead to sideropenic anemia (anemia due to loss of iron). Iron is necessary for proper function of hemoglobin in red blood cells.

Causes Of Menorrhagia

Besides cases in which menorrhagia exists from the beginning of a woman's reproductive period, it can also start suddenly at any age. The most common cause is a hormonal imbalance induced by different factors, such as contraceptive pills, especially postcoital contraception (morning-after pills). After pregnancy, a woman's hormonal status is often out of balance for a little while, so menorrhagia can occur during that time too. Increased menstrual bleeding with blood clots can also appear in the premenopausal period.

Uterine polyps and fibroids are benign tumors of the uterus and they can produce increased bleeding which is called metrorrhagia. Malignant tumors of the cervix and uterus are usually asymptomatic at first, but with further growth, they can lead to significant metrorrhagia.


Treatment of menorrhagia depends on the cause of bleeding. Most women do not require any treatment if they occasionally have "heavy days". In cases of hormonal imbalance, hormone replacement therapy in the form of contraceptive pills can be used to keep the bleeding under control. Menorrhagia caused by benign and malignant tumors will often necessitate surgery, and further treatment according to medical protocols will be prescribed by your doctor.

In some severe cases, if a woman does not plan to have children, uterectomy (removal of the uterus) can be performed. This procedure eliminates periods completely.

Women suffering from sideropenic anemia due to increased menstrual bleeding should make sure to intake enough iron-rich food and take iron supplements. The anemia is spontaneously cured after menopause.

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