Menorrhagia or heavy periods, is a symptom of an underlying gynaecological condition.

Some women may have the condition right from the onset of menses while some develop it during their reproductive period.

In some cases there may be heavy bleeding after stoppage of periods or after menopause.

Four types of causes of Menorrhagia

Causes of Menorrhagia may be of basic four types (1-4) –

• Organic – Disease or infections of the gynaecological organs like ovaries, uterus etc. This also includes medical disorders that may lead to heavy bleeding like bleeding disorders etc.
• Endocrinologic – Hormonal disorders including those of the reproductive organs like ovaries as well as others like the thyroid gland
• Anatomic causes includes polyps, fibroids etc. of the uterus, over growth of the endometrium or pregnancy
• Iatrogenic – Literally meaning caused by anything prescribed by the doctor. This could be due to drugs, intrauterine contraceptive devices etc.

Causes of Menorrhagia

Causes of Menorrhagia may be outlined as (1-4):

1. In most cases (40-60%) the cause of Menorrhagia is unknown. This is called dysfunctional uterine bleeding and affects four to six out of ten cases.

   These patients have normal ovaries, uterus and hormone levels. Their ovaries release the egg regularly and normally (a process called ovulation) and the periods are regular.

   DUB is commonly seen at the beginning of menses in adolescence and nearing menopause. Some researchers believe that this could be due to a chemical called prostaglandin. The endometrium is more sensitive to prostaglandins and it dilates the blood vessels of the uterus leading to excessive bleeding.

2. Endometriosis is another cause for heavy bleeding.
3. Infections of the pelvis. Chlamydial infections may lead to Menorrhagia.
4. Medical conditions like bleeding or blood clotting disorders may lead to Menorrhagia. In these patients there is deficiency of enzymes and agents that cause blood to clot after a bleeding episode or wound or injury. This leads to excessive bleeding. Bleeding disorders are a common cause of Menorrhagia.
5. Medical disorders of the heart, kidneys, liver or thyroid may also lead to Menorrhagia.
6. Hormonal disturbances may also lead to heavy bleeding. Women who do not ovulate regularly (e.g. those suffering from polycystic ovary syndrome) and those with an underactive thyroid may suffer from Menorrhagia.
7. A common cause of heavy menstrual bleeding is a growth of tissues within the uterus. These are usually non-cancerous or benign. Types of benign growths that can lead to heavy bleeding may be –
   • Myomas or uterine fibroids that are growths in the muscle layer of the uterus.
   • Polyps or small, soft out-pouching of endometrial tissues that line the inner walls of the uterus.
8. Bleeding may also occur due to malignant or cancerous growths in the uterus or cervix (mouth of the womb).
9. Women who are using an intrauterine contraceptive device (IUCD, or coil) may complain of Menorrhagia. Newer devices that also release hormones called the intrauterine system (IUS) however can help treat heavy priods.
10. Some drugs may lead to heavy bleeding. These include Warfarin, Aspirin and cancer chemotherapy drugs. The first two drugs lead to deficiency in blood clotting mechanism and lead to heavy menstrual bleeding.