Menstruation: Heavy Bleeding (Menorrhagia)

Description

Alternative Names

Menstrual Disorders

During normal menstruation the average woman loses about 2 ounces (60 ml) of blood or less. If bleeding is significantly heavier, it is called menorrhagia, which occurs in 9% to 14% of all women and can be caused by a number of factors. Women often over estimate the amount of blood lost during their periods. However, women should consult their physician if any of the following occurs:

• Soaking through at least one pad or tampon every hour for several hours.
• Heavy periods that regularly lasting 10 or more days.
• Bleeding between periods or during pregnancy. Spotting or light bleeding between periods is common in girls just starting menstruation and sometimes during ovulation in young adult women, but consultation with a physician is nevertheless recommended.

Note: Clot formation is fairly common during heavy bleeding and is not a cause for concern.

Other Menstrual Disorders

Amenorrhea (Absence of Menstruation). Amenorrhea is the absence of menstruation. There are two categories: primary amenorrhea and secondary amenorrhea. Such terms are used only to describe the timing of menstrual cessation; they do not indicate any cause nor do they suggest any other information.

• Primary amenorrhea occurs when a girl does not even start to menstruate. Girls who show no signs of sexual development (breast development and pubic hair) by age 14 should be evaluated. Girls who do not have their periods by two years after sexual development should also be checked. Any girl who does not have her period by age 16 should be evaluated for primary amenorrhea.
• Secondary amenorrhea occurs when periods that were previously regular become absent for at least three cycles. [For more details, see the Well-Connected Report # 101, Amenorrhea.]

Oligomenorrhea (Light or Infrequent Menstruation). Oligomenorrhea is a condition in which menstrual cycles are infrequent. It is very common in early puberty and not usually worrisome. When girls first menstruate they often do not have regular cycles for a couple of years. Even healthy cycles in adult women can vary by a few days from month to month. In some women, periods may occur every three weeks and in others, every five weeks. Flow also varies and can be heavy or light. Skipping a period and then having a heavy flow may occur; this is most likely due to missed ovulation rather than a miscarriage. Women should be concerned when periods come less than 21 days or more than three months apart, or if they last more than ten days. Such events may indicate ovulation problems.

Dysmenorrhea (Severe Menstrual Cramps). Uterine contractions occur during all periods, but in some women these cramps can be frequent and very intense. In such cases the condition is known as dysmenorrhea. It can be primary or secondary.

• Primary dysmenorrhea is caused by normal uterine muscle contractions and affects more than half of menstruating women. It usually starts two to three years after the periods have started. The pain usually develops when the bleeding starts and continues for 32 to 48 hours.
• Secondary dysmenorrhea is menstrually related pain that is caused by other medical conditions, usually endometriosis or pelvic abnormalities. [For more information, see Well-Connected Report #100, Dysmenorrhea.]

Up to 80% of all women report some symptoms related to fluctuating hormone levels as menstruation approaches. For about half of these women, symptoms are mild and do not affect normal daily life. The other half report symptoms severe enough to impair daily life and relationships.

Premenstrual Syndrome. In general premenstrual syndrome (PMS) is a set of physical, emotional, and behavioral symptoms that occur during the last week of the luteal phase (a week before menstruation) in most cycles. The symptoms should typically resolve within four days after bleeding starts and not start until at least day 13 in the cycle. Women may begin to experience premenstrual syndrome symptoms at any time during their reproductive years. Once established, the symptoms tend to remain fairly constant until menopause, although they can vary from cycle to cycle. About 100 symptoms have been identified with the premenstrual phase. [For more details, see Well-Connected Report #79, Premenstrual Syndrome.]

The cause of premenstrual syndrome is not known but severe symptoms have been shown to be responsive to lifestyle changes. Getting exercise several times a week, eating a balanced diet, getting adequate sleep, and reducing or eliminating caffeine and alcohol are some of the changes most often recommended.