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Causes
By Mayo Clinic staffIn some cases, the cause of heavy menstrual bleeding is unknown, but a number of conditions may cause menorrhagia. Common causes include:
- Hormonal imbalance. In a normal menstrual cycle, a balance between the hormones estrogen and progesterone regulates the buildup of the lining of the uterus (endometrium), which is shed during menstruation. If a hormonal imbalance occurs, the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding.
- Dysfunction of the ovaries. Lack of ovulation (anovulation) may cause hormonal imbalance and result in menorrhagia.
- Uterine fibroids. These noncancerous (benign) tumors of the uterus appear during your childbearing years. Uterine fibroids may cause heavier than normal or prolonged menstrual bleeding.
- Polyps. Small, benign growths on the lining of the uterine wall (uterine polyps) may cause heavy or prolonged menstrual bleeding. Polyps of the uterus most commonly occur in women of reproductive age as the result of high hormone levels.
- Adenomyosis. This condition occurs when glands from the endometrium become embedded in the uterine muscle, often causing heavy bleeding and pain. Adenomyosis is most likely to develop if you're a middle-aged woman who has had many children.
- Intrauterine device (IUD). Menorrhagia is a well-known side effect of using a nonhormonal intrauterine device for birth control. When an IUD is the cause of excessive menstrual bleeding, you may need to remove it.
- Pregnancy complications. A single, heavy, late period may be due to a miscarriage. If bleeding occurs at the usual time of menstruation, however, miscarriage is unlikely to be the cause. An ectopic pregnancy — implantation of a fertilized egg within the fallopian tube instead of the uterus — also may cause menorrhagia.
- Cancer. Rarely, uterine cancer, ovarian cancer and cervical cancer can cause excessive menstrual bleeding.
- Inherited bleeding disorders. Some blood coagulation disorders — such as von Willebrand's disease, a condition in which an important blood-clotting factor is deficient or impaired — can cause abnormal menstrual bleeding.
- Medications. Certain drugs, including anti-inflammatory medications and anticoagulants (to prevent blood clots), can contribute to heavy or prolonged menstrual bleeding. Improper use of hormone medications also can cause menorrhagia.
- Other medical conditions. A number of other medical conditions, including pelvic inflammatory disease (PID), thyroid problems, endometriosis, and liver or kidney disease, may cause menorrhagia.
References
- Jurema M, et al. Menorrhagia. http://www.uptodate.com/home/index.html. Accessed April 25, 2009.
- Excessive menstrual bleeding: Quick primer. National Women's Health Information Center. http://www.healthywomen.org/aub/pg1.html. Accessed April 25, 2009.
- Women and anemia — Heavy menstrual bleeding and fibroids. National Anemia Action Council. http://www.anemia.org/patients/featurearticles/content.php?contentid=000242§ionid=00015. Accessed April 25, 2009.
- Vaginal bleeding. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec18/ch242/ch242e.html. Accessed April 25, 2009.
- Abnormal uterine bleeding. The American College of Obstetricians and Gynecologists. http://www.acog.org/publications/patient_education/bp095.cfm. Accessed April 25, 2009.
- Questions to ask about excessive menstrual bleeding. National Women's Health Information Center. http://www.healthywomen.org/aub/pg3.html. Accessed April 25, 2009.
- Menstrual periods fact sheet. The American College of Obstetricians and Gynecologists. Accessed April 25, 2009.
- Goodman A. Terminology and evaluation of abnormal uterine bleeding in premenopausal women. http://www.uptodate.com/home/index.html. Accessed April 25, 2009.
- de Silva NK, et al. Definition and evaluation of abnormal uterine bleeding in adolescents. http://www.uptodate.com/home/index.html. Accessed April 25, 2009.
- Lobo RA. Abnormal uterine bleeding: Ovulatory and anovulatory dysfunctional uterine bleeding, management of acute and chronic excessive bleeding. In: Katz VL, et al., eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa.: Mosby; 2007. http://www.mdconsult.com/das/book/body/133793247-3/834086474/1524/248.html#4-u1.0-B978-0-323-02951-3..50040-6_1192. Accessed April 25, 2009.
- Cervical cancer screening. Centers for Disease Control and Prevention. http://www.cdc.gov/cancer/cervical/basic_info/screening/. Accessed April 25, 2009.
- Gallenberg MM (expert opinion). Mayo Clinic, Rochester, Minn. April 29, 2009.
