The menorrhagia can only concern women between the age of puberty and the age of menopause. Indeed, they (hypermenorrhea) correspond to abnormally menstruation abundant and prolonged. It is the most common menstrual disorder reported by women. The amount of blood normally lost during menstruation averages 2 oz (4 tbsp) and the usual length of time varies between 3 and 7 days. A woman with menorrhagia can lose up to 3 oz (6 tbsp) or more and sometimes over a period of more than 7 days. Menorrhagia are sometimes accompanied by abdominal pain affecting the quality of life of women who suffer from it. In some cases, it can be responsible for anemia.

Almost 1 in 20 women aged 30 to 49 see a doctor each year for menorrhagia. Obviously, this is always a subjective assessment, since it is difficult to measure the amount of blood lost during menstruation.

In addition to menorrhagia (which is an exaggeration of menstruation), unusual bleeding (more or less important) can occur between 2 periods of rules: if they are very light and occasional, we speak of ” spotting “; if they are important or almost permanent, we speak of ” bleeding “. They do not always have the same meaning as menorrhagia: menorrhagia are periods whose duration and abundance are important (always or recently); while spotting and bleeding is bleeding that is not related to the cycle.

The presence of a uterine fibroid (benign tumor in the lining of the uterus) can cause heavy periods (menorrhagia) and bleeding between periods (metrorrhagia) but also one or the other.

Note : if menorrhagia can be painful, metrorrhagia and spotting, if they are light, are most often painless. The pain is caused by the contractions of the uterus, not the bleeding itself, and being in pain does not mean that the bleeding is severe.

Causes

The menstruation are the elimination, at the end of an ovulatory cycle, of the interior wall of the uterus (endometrium), made up of abundant cells and blood. Menstruation is not a simple bleeding but a “molting” of the interior wall of the uterus. This, to accommodate a pregnancy, must indeed be made up of “fresh” cells. When the’ovulation of the month was not followed by pregnancy, the drop in hormones in the blood leads to evacuation of the inner lining of the uterus and contractions of the uterus which detach the endometrium and expel it. After your period is over, theendometrial reform in the next cycle in anticipation of the next ovulation and possible pregnancy.

The most common cause of unusual vaginal bleeding is hormonal fluctuation. The secretion of estrogen and progesterone influences endometrial growth and ovulation; their drop in the blood leads to the onset of menstruation. But sometimes ovulation does not occur (anovulatory cycle) or later. The endometrium then continues to form, until theuterus end up expelling him anyway. The endometrium has grown longer so more and there is more thickness to remove, which results in menorrhagia.

The cycles without ovulation are frequent in early adolescence and perimenopause, but they can also occur anytime up to menopause. A missed period of a few days may be followed by a heavier period than usual because ovulation has been delayed.

A late period of more than 15 days accompanied by heavy bleeding can sometimes correspond to a miscarriage. In this case, a pregnancy test turns out to be positive.

Note that miscarriages occurring at less than 3 months are almost always linked to the non-viability of the embryo. A miscarriage does not usually indicate a fertility problem. It is only if 3 or more of them occur in a row that an exploration should be carried out.

Other causes of menorrhagia or bleeding unusual vaginal:

• The presence of benign tumors in the womb, such as uterine fibroids or polyps (a slender growth that occurs on a mucous membrane), is also a common cause of menorrhagia or unusual bleeding, especially after 35 years of age;
• Taking a hormonal treatment (contraception, treatment of menopause, fertility treatment) may cause menorrhagia and irregular bleeding (spotting or bleeding). Many users of birth control pills, especially when they are not suitable, may experience “spotting” or bleeding. 
• Users of a copper intrauterine device (IUD) may have a much heavier period. 
• Users of hormonal IUDs generally have much less heavy periods… Except for a few women who may have menorrhagia;
• Spotting after sex may be due to pill or a ill-adapted hormonal treatment, or inflammation (most often benign) of the cervix. But it can also be due to a genital infection or cervical cancer. It must therefore absolutely lead to a consultation if it recurs;
• L’endometriosis, abnormal development of endometrial tissue outside the uterus, may be related to heavy periods, which passes through the tubes and not through the vagina. Severe abdominal pain occurring after menstruation, in the days following the cessation of bleeding, are very suggestive of endometriosis;
• Unusual bleeding in a woman over 40 not using contraception may be related to inflammation or cervical cancer and require a consultation as soon as possible.
• Bleeding in a postmenopausal woman is not menorrhagia. These are hemorrhages and they must lead to a rapid consultation.
• Bleeding in a pregnant woman is never menorrhagia, since a pregnant woman does not have a period. This bleeding should lead to a prompt medical consultation.

Here are other possible causes, but rarer:

• Other conditions of the genitals: pelvic infection (salpingitis), cancer of the ovaries, cancer of the endometrium;
• Taking certain medications (anticoagulants, aspirin taken in large quantities, chemotherapy);
• Various diseases: thyroid disorders, lupus, an inherited bleeding disease such as von Willebrand disease;

Complications

The most common complication of menorrhagia is iron deficiency anemia (iron deficiency anemia). Heavy or repeated bleeding depletes the body’s iron stores, which can no longer make enough red blood cells. About 10% of women of childbearing age have iron deficiency anemia. To have anemia, it suffices to have heavy or a little long periods (more than 7 days) and frequent (every 25 days…) and not absorbing enough iron.

The bleeding severe and sudden or very painful can lead to fainting or severe weakness. They then require an emergency consultation.

The pain are not necessarily linked to the severity of the bleeding but above all to its abundance and to the personal sensitivity of each woman.