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Heavy menstrual bleeding (also called menorrhagia) is excessive menstrual bleeding occurring at regular intervals or prolonged menstrual bleeding lasting more than seven days. 1 Menorrhagia can often interfere with your usual daily activities due to excessive bleeding and cramping. 2 Heavy menstrual bleeding is a common condition, affecting 1 in 4 women, at some point in their life. 3

Signs & Symptoms of Heavy Menstrual Bleeding

These include: 2

  • Bleeding for longer than a week
  • Soaking through one or more sanitary towels/ tampons every hour for several hours in a row
  • Needing to double up on sanitary towels to control your menstrual flow
  • Needing to wake up to change sanitary towels/tampons during the night
  • Passing blood clots larger than a R5 coin
  • Restricting daily activities due to heavy menstrual flow

Causes of Heavy Menstrual Bleeding

Between 40 and 60 % of cases of heavy menstrual bleeding no underlying cause can be found. 4

Causes include: 2

  • Hormone imbalance such as thyroid dysfunction
  • Inherited bleeding disorders
  • Fibroids or polyps in the uterus (benign growths on the inner wall of the uterus)
  • Endometriosis (a condition in which the tissue lining the uterus is found outside of the uterus)
  • Cancer of the lining of the uterus (endometrial cancer)
  • Medications
visual: comparison of normal blood cells and anemia

Complications of Heavy Menstrual Bleeding

Up to 8 out of 10 women with heavy menstrual bleeding experience a decrease in their quality of life, including physical, psychological or social well-being.5,6

The 2 most common complications are: 2

  • Severe pain (or dysmenorrhoea)
  • Iron deficiency anaemia – anaemia is a reduction in the number of red blood cells, which store and carry oxygen in the blood, so a reduction means that your organs and tissues won’t get as much oxygen as they usually would. 7

This can lead to: 7

  • Tiredness and a lack of energy (lethargy)
  • Shortness of breath
  • Palpitations (noticeable fast heartbeat)
  • A pale complexion

Treatment of Heavy Menstrual Bleeding

There are many effective treatments for menorrhagia that cater to the differing needs of each woman. 3

Initial treatment is usually with medication: 3

  • Hormonal treatment e.g. oral contraceptives
  • Non-hormonal treatment e.g. anti-inflammatory drugs

Sometimes surgical procedures are necessary depending on the exact cause e.g. cancer, the severity of the symptoms and the response to medication. 3

If you dread your period because you have very heavy menstrual bleeding, talk with your doctor. To get the best advice, record your symptoms, track the length of your period and make a note of how many sanitary towels or tampons you are using. This will help the doctor better understand your situation. Speak to your Medicare Pharmacy healthcare professional about our doctor video consultations.

References: 1. Apgar BS, Kaufman AH, George-Nwogu U, Kittendorf A. American Family Physician. Treatment of Menorrhagia. [online] 2007 Jun 15 [cited 2018 Jun 22]. Available from URL: 2. Mayo Clinic. Menorrhagia (heavy menstrual bleeding). [online] 2017 July 15 [cited 2018 Jun 22]. Available from URL: 3. Singh S, Best C, Dunn S, Leyland N, Wolfman WL. Abnormal Uterine Bleeding in Pre-Menopausal Women. J Obstet Gynaecol Can 2013;35(5 eSuppl):S1-S28. 4. Kaloo P, Davies S. Case discussion: Heavy menstrual bleeding in Primary Care and beyond. J Fam Med 2014;2 (4). Available from URL: 5. National Institute for Health and Care Excellence (NICE). Heavy menstrual bleeding: assessment and management. [online] 2018 March 01 [cited 2018 Jun 22]. Available from: URL: 6. Winkler UH. The effect of tranexamic acid on the quality of life of women with heavy menstrual bleeding. Eur J Obstet Gynecol Reprod Biol 2001;99:238-243. 7. NHS Choices. Iron deficiency anaemia – information prescription. [Online] [cited 2016 Nov 17]. Available from: URL: http:///

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