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Menorrhagia or heavy periods are most often a symptom of an underlying condition rather than a disease in itself.
Symptoms of menorrhagia include heavy bleeding with normal regularity of menstrual cycles. Bleeding periods usually last longer than 7 days.
Quantity of the bleeding might be a subjective parameter.
An average tampon, for example holds 5 mL and the average pad holds 5-15 mL of blood.
The patient is asked about the type of pad or tampon and the amount may be calculated. The patient may need more than a single pad to cover the flow.
Sometimes she may need frequent changing and need to wake up at nights to change her pad.
Quality of bleeding involves the amounts of clots and their size that is passed. Quality of life, day to day activities and social life may also be affected due to heavy bleeding.
Young patients in their adolescence who have just begun their menses may suffer heavy bleeding.
This is mainly because their ovaries do not release the egg at each cycle. Since there is no ovulation, these cycles are called anovulatory cycles.
This population may also suffer from hormonal disbalances leading to Menorrhagia.
If there is no response to usual therapy bleeding disorders may be suspected.
Middle aged women between 30 and 50 may have an underlying uterus fibroid or polyps leading to heavy periods. This population may also be affected by other disease like thyroid disease, kidney or liver disease.
Women after menopause who have Menorrhagia may be harbouring a uterus cancer and need to be evaluated.
Pelvic pain is another symptom of Menorrhagia. This may be seen in Menorrhagia due to infections.
If there are pelvic infections there may be other symptoms like fever, chills, copious vaginal secretions etc.
Menorrhagia due to intrauterine device (IUD) is usually accompanied with cramping pains as well
If Menorrhagia is caused due to hormonal disbalance due disease like polycystic ovarian syndrome there may be other symptoms like hirsuitism (excessive hair over the face) and acne.
Milk secretion or galactorrhea may be seen in women with pituitary tumors. If there is Menorrhagia due to pituitary tumors there may be galactorrhea.
If there is an underlying bleeding disorder there may be excessive bruising and continued or prolonged bleeding after injury.
Symptoms of liver and kidney disease may be seen if there is an underlying disorder. Those with thyroid disorders may have symptoms of the disease in addition to Menorrhagia.
If there is excessive and prolonged Menorrhagia there may be symptoms of anemia. This is usually manifested in excessive weakness, easy fatigue, pale skin (visible over palms and soles of the feet) and mucous membranes (insides of the mouth tongue etc.) etc.
Some red flag symptoms mean there is a serious underlying disease that needs to be investigated.
These include bleeding after sexual intercourse, continued heavy bleeding throughout the menstrual cycle, pain over the vulva and cramps during menstruation, feeling of pressure over the lower abdomen, excessive vaginal discharge etc. (1-5)