Menorrhagia is a term used to describe excessive menstrual flow and duration. Clinically, menorrhagia is described as blood loss exceeding 80mls per cycle or menses/period lasting beyond 7 days. It is a very common gynecologic problem. It can occur alone or in combination with other symptoms.

Any female of reproductive age who is menstruating may develop menorrhagia. Typically, menorrhagia in adolescent girls is due to anovulation while in older women, it is as a result of an underlying problem within the uterus or outside the uterus/systemic.

Generally in clinical practice, identifying menorrhagia is subjective.  Diagnosis is based on the woman’s description of menstrual blood loss and how it is interferes with her physical, social, and emotional quality of life.

While heavy blood loss may be so severe and relentless affecting daily activities, the good news is there are treatments to help.

As stated in earlier article, the-menstrual-cycle is a tightly controlled physiological process which is easily influenced by a lot of factors both within and outside the female reproductive system.

What are the causes of Menorrhagia?

The factors inducing excessive menstrual bleeding or longer than normal duration of menstrual flow can be broadly grouped into:

  1. Those within the uterus
  2. Those outside the uterus

Those within the uterus:

  • Uterine fibroids- uterine fibroid may cause heavier than normal and prolonged menstrual bleeding.
  • Endometrial polyps – Small outgrowths on the lining of the uterus may cause heavy or prolonged menstrual bleeding.
  • Endometriosis – when the inner lining of the uterus extends outside the uterus, it results in abnormal bleeding and pain.
  • Adenomyosis – This condition occurs when glands from the inner lining of the uterus/womb become embedded in the uterine muscle, often causing heavy bleeding and painful periods.
  • Pelvic inflammatory disease (PID) – This is an infection of the reproductive organs in women.
  • Endometrial hyperplasia – is the abnormal thickening of the inner lining of the uterus due to hormonal imbalance.
  • Cancer – Uterine cancer and cervical cancer can cause inordinate menstrual bleeding.
  • Intrauterine contraceptive device (IUD) – Menorrhagia is a common side effect of using a non hormonal intrauterine device for birth control.
  • Pregnancy complications- A single, heavy, late period may be due to a miscarriage or ectopic pregnancy (pregnancy outside of the uterus). Another cause of heavy bleeding during pregnancy includes an unusual location of the placenta, such as a low-lying placenta.
  • Dysfunction of the ovaries- If the ovaries don’t release an egg (ovulate) during a menstrual cycle (anovulation); the body doesn’t produce the hormone progesterone, as it ought to during a normal menstrual cycle. This sparks hormone imbalance and may give rise to menorrhagia.


Those outside the uterus

  • Hormonal imbalance – In a normal menstrual cycle, a continuous balance occurs between the hormones estrogen and progesterone which regulate the increase in the inner lining of the uterus (endometrium), which is shed during menstruation. A disruption to this equilibrium results in excessive development of the endometrium and eventual shedding 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.

  • Chronic liver disease – Chronic liver disease hinders production of substances that helps with blood clotting and reduces breakdown of hormones like estrogen. Either of these problems may lead to heavy uterine bleeding.
  • Chronic renal disease
  • Bleeding disorders- with the shedding of an endometrial (inner part of uterus) lining’s blood vessels, normal blood clotting process must occur to limit and eventually stop the blood flow. Any disruption to this process due to blood disorder will increase blood loss during menstruation.
  • Drugs – Hormonal medications like estrogen and progestins, and drugs that prevent blood clotting can give rise to heavy or prolonged menstrual bleeding.

What are the symptoms of menorrhagia?

  • Soaking through one or more sanitary material every hour for several consecutive hours
  • Use of double sanitary material to control your menstrual flow
  • Waking up during the night to change sanitary material
  • Bleeding for longer than 7 days
  • Passing several blood clots
  • Restricted daily activities due to heavy menstrual flow
  • Symptoms of anemia, such as tiredness, fatigue or shortness of breath
  • Symptoms of low blood level such as tiredness, fatigue or shortness of breath

When to see a doctor

If you have bleeding that lasts longer than 7 days per period, or is so heavy requiring you to change your sanitary material nearly every hour or you experience any of the other symptoms stated above, you need to talk to a doctor.


Finding out if a woman has heavy menstrual bleeding could be quite herculean because each person might think of heavy bleeding differently.

The second and concluding part of the article will be focused on diagnosis and various treatment options for Menorrhagia.

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