Heavy Menstrual Bleeding – Diagnosis and Treatment

Diagnosis

When someone has heavy or unusual menstrual bleeding, a healthcare provider will first ask about their health and details about their menstrual cycles.

It helps a lot if they keep a daily record. In this diary, they write down when bleeding starts and ends, how heavy the flow is, and how many sanitary pads or tampons they use.

This information shows if the bleeding matches menorrhagia, anovulatory bleeding, or another menstrual disorder. Next, the provider does a pelvic exam to check for growths or changes in the uterus or cervix.

After this, they may order some tests:

Test or Procedure	Purpose
Blood tests	Look for anemia, check thyroid, and rule out bleeding disorders
Pap test (Pap smear)	Screen for cervical changes or early signs of cervical cancer
Endometrial biopsy	Check for cancer or precancer inside the uterus
Ultrasound scan	Image the uterus and ovaries for fibroids, polyps, or other changes

If they need more information, other tests can help find problems inside the uterus.

• Sonohysterography: The provider places fluid into the uterus and then does an ultrasound. This test looks for endometrial polyps, fibroids, or changes in the uterine lining.

• Hysteroscopy: The provider passes a thin, lighted tube through the vagina and cervix. This tool lets them see inside the uterus directly and check for growths like uterine polyps or endometrial cancer.

Doctors also check for causes outside the uterus, such as hormonal imbalances, hypothyroidism, or certain medicines. Bleeding disorders or anemia can make periods heavier than normal.

People should always get checked if they have heavy or prolonged bleeding (lasting more than 7 days or soaking pads every 2 hours).

Doctors diagnose abnormal uterine bleeding or menorrhagia only after ruling out other problems. Some causes include uterine fibroids, endometriosis, adenomyosis, or, rarely, uterine or cervical cancer.

If postmenopausal bleeding happens or bleeding seems unusual for age or cycle, people should get checked for cancer.

Treatment

Medicine Choices For Reducing Bleeding

Various medicines can help control heavy menstrual flow. The right medicine depends on health needs, the cause of bleeding, and future childbearing plans.

Common choices include:

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Medicines like ibuprofen and naproxen lower menstrual blood loss and ease cramping.

Medicine Name	Purpose	When Taken
Ibuprofen	Reduces bleeding, cramps	During period
Naproxen	Reduces bleeding, cramps	During period

• Anti-Fibrinolytic: This medicine helps stop the breakdown of blood clots, which makes periods lighter.
• Hormonal Birth Control: Pills, patches, or vaginal rings make periods more regular and lighter. These options also treat hormone imbalances causing heavy bleeding.
• Progesterone Tablets: Taken for a set part of the menstrual cycle, these pills balance hormones and help with abnormal bleeding.
• Hormonal IUDs: Devices are placed in the uterus. They release a hormone called progestin, which thins the uterine lining and lessens monthly blood flow.
• Other Hormonal Medicines: GnRH agonists and antagonists lower hormone levels to control bleeding. Some pills are used if fibroids or endometriosis are the cause.
• Iron Supplements: Heavy periods can cause or worsen anemia. If iron levels drop, iron pills or liquids may be needed.

Quick Overview Table: Common Medication Options

Category	Type	Key Effect
Nonhormonal	NSAIDs, Anti-fibrinolytic	Reduces volume, soothes pain
Hormonal Birth Control	Pill, Patch, Vaginal Ring, Hormonal IUD	Balances periods, lightens flow
Progesterone	Oral Progestin	Controls hormonal balance
Other Hormonal Medicines	GnRH Agonist/Antagonist	Reduces hormone impact
Supplements	Iron	Treats and prevents anemia

Anyone on blood thinners or other long-term medicines should talk to their healthcare provider before starting any new treatment for heavy menstrual bleeding.

Stopping or changing hormone-based medicines may also help if they are causing extra bleeding.

Surgical And Device Procedures For Severe Bleeding

Doctors may recommend procedures when medicines do not help or if underlying causes such as fibroids are present. The best treatment depends on symptoms, future fertility plans, and overall health.

Main options include:

Procedure Name	Aim	Notes
Dilation and Curettage (D&C)	Removes uterine tissue.	Can diagnose or treat causes.
Hysteroscopic Myomectomy	Removes fibroids inside the uterus.	Helpful for future pregnancy plans.
Endometrial Ablation	Destroys uterine lining.	Not for those planning pregnancy.
Endometrial Resection	Removes endometrial tissue.	Not recommended for future fertility.
Uterine Artery Embolization	Blocks blood to fibroids.	Fibroids shrink, uterus spared.
Focused Ultrasound	Targets fibroids with sound waves.	Non-invasive, no incisions.
Laparotomy	Open surgery for fibroids or uterus.	Longer recovery, larger incision.
Laparoscopic Myomectomy	Removes fibroids by keyhole cuts.	Shorter recovery, minimal scarring.
Hysterectomy	Removes uterus (and cervix/ovaries).	Permanent, ends periods and pregnancy.

• Dilation and Curettage (D&C): The provider widens the cervix and gently removes tissue from the uterus. This can find or treat sources of heavy bleeding, such as polyps or a thickened uterine lining.

• Hysteroscopic Myomectomy: If fibroids cause heavy flow, the provider removes fibroids from inside the uterus using thin instruments. This surgery can help preserve the uterus for future pregnancies.

• Endometrial Ablation: The provider destroys the tissue lining the uterus using heat, laser, or radio waves. After ablation, periods get much lighter or may stop. Pregnancy is not recommended after ablation, so effective contraception should be used.

• Endometrial Resection: An electric wire loop removes parts of the uterine lining. This technique is similar to ablation in its effects. It is not suitable for those who want children later.

• Uterine Artery Embolization: The provider blocks blood supply to fibroids using tiny beads, causing them to shrink. This method does not need large incisions, and recovery time is often short.

• Focused Ultrasound: Ultrasound waves target fibroids to heat and destroy them without cutting into the body.

• Myomectomy (Laparoscopic or Abdominal): The provider removes fibroids while leaving the uterus in place. Depending on the size and location of fibroids, the surgery is done through small cuts in the belly (laparoscopy) or a larger cut (laparotomy).

• Hysterectomy: The provider removes the uterus and sometimes the cervix and ovaries. This surgery stops menstrual bleeding completely and is the only way to cure heavy periods for good. Recovery may need a hospital stay, especially if the surgery is done through an abdominal incision. Removing the ovaries (oophorectomy) can bring on early menopause.

Most of these options let people return home the same day, especially if done with small incisions or through the vagina. Abdominal surgeries and hysterectomy might require more time in the hospital.

Getting Ready for Your Visit

Steps to Take Before Your Visit

Before the appointment, prepare a list to bring with you. Write down all symptoms, including details about the menstrual cycle, any changes in flow, and if there have been menstrual cramps or new pain.

Note any family history of conditions related to heavy bleeding or obesity, as well as big life events or recent stress. List all medicines, vitamins, and supplements you use, including the amounts.

Organize any questions you want to ask about menorrhagia symptoms, possible causes, tests you might need, or ways to manage dysmenorrhea. If there are other ongoing health problems, include questions about combining care for these issues.

Sample Table of Items to Bring:

Item	Details
Symptoms	Type, frequency, severity
Medications & Supplements	Names, dosages
Family History	Relevant illnesses
Lifestyle factors	Weight changes, stress
Questions for Provider	Prepared list

Consider asking a trusted family member or friend to join you for support and to help remember advice from the healthcare provider.

Questions You May Get From the Healthcare Team

At your visit, the healthcare provider will likely ask questions to learn more about your symptoms.

Common topics include when the problem began, if the symptoms are always present or come and go, and how intense the bleeding or cramps have been.

They may also ask what relieves or worsens symptoms. Sharing complete and honest answers makes it easier to find the best care.

How to Take Care of Yourself While Waiting

Until you see the doctor, avoid activities that make bleeding, pain, or cramping worse. Monitor your symptoms, including the length and heaviness of each period.

Track the number of pads or tampons you use each day. This information will help you at your appointment.