Heavy Menstrual Flow (Menorrhagia)

What it is

Menorrhagia is heavy or prolonged menstrual flow that requires frequent pad changes, comes with clots, and lasts more than seven days. It affects about one in four women of reproductive age and is more common after age 40, but it can occur at any stage. Besides the discomfort and the limits it places on daily activities, excessive bleeding leads to iron-deficiency anemia, with fatigue, weakness, and reduced performance. Causes range from hormonal imbalances to fibroids, polyps, adenomyosis, and bleeding disorders. The gynecology team at Femi Saúde investigates the source of the bleeding and proposes the appropriate treatment for each case.

Most common symptoms

• Needing to change pads every one to two hours
• Periods lasting more than seven days
• Large clots, coin-sized or bigger
• Nighttime leaks and the need for double protection
• Fatigue, weakness, dizziness and shortness of breath
• Stronger cramps during heavy flow

Causes and risk factors

• Anovulatory cycles and hormonal imbalances
• Fibroids, polyps and adenomyosis
• Bleeding disorders, such as von Willebrand disease
• Thyroid disorders
• Copper IUD use and anticoagulant medications
• Endometrial hyperplasia and, rarely, cancer

How it is diagnosed

The evaluation starts with the menstrual history, estimating flow volume, duration, the presence of clots, and the impact on daily routine, along with medication use and any history of bleeding in other situations. The gynecological exam looks for changes in the cervix and uterus. A complete blood count and ferritin measure anemia and iron stores; thyroid hormones and coagulation tests are ordered as needed. Transvaginal ultrasound assesses fibroids, polyps, adenomyosis, and endometrial thickness. When a lesion inside the uterine cavity is suspected, hysteroscopy with endometrial biopsy completes the work-up.

How we treat it at Femi Saúde

Treatment depends on the cause, age, and whether pregnancy is desired. For hormonal causes, the gynecology team at Femi Saúde may prescribe anti-inflammatories and antifibrinolytics during the flow, hormonal contraceptives, progestogens, or the hormonal IUD, which significantly reduces menstrual volume. Iron supplementation corrects the anemia. Polyps and fibroids inside the uterine cavity can be removed by surgical hysteroscopy; larger fibroids, by myomectomy. Endometrial ablation and hysterectomy are options for those who have completed their family planning. Bleeding disorders are treated jointly with hematology. The plan is individualized and reviewed during follow-up.

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