Menometrorrhagia also known as abnormal uterine bleeding, is when you bleed between your monthly periods or when your periods are extremely heavy and/or prolonged. Normal menstrual flow typically lasts about five days and occurs every 21 to 35 days.
When it comes to menstrual cycles, there’s a wide range of “normal.” But your period shouldn’t be a problem for your month after month. If it’s so heavy or unpredictable that it keeps you from doing some activities or makes you miss work or school, you may have a medical condition that should be treated.
Your provider should know about any abnormal bleeding you’re experiencing. What’s causing your bleeding may be harmless. But your bleeding may be a sign of cancer or conditions that may negatively impact your fertility.
There’s a difference between menometrorrhagia and menorrhagia.
Menometrorrhagia was once an umbrella term for two different conditions that sound nearly the same:
- Metrorrhagia: excessive, prolonged and/or irregular bleeding unrelated to menstruation.
- Menorrhagia: excessive and/or prolonged menstruation.
Not everyone who experiences abnormal uterine bleeding reports their symptoms. As a result, 10% to 35% of women worldwide may have abnormal uterine bleeding. But the numbers may be higher. It’s most common during menarche (when menstruation begins) and perimenopause (the years leading up to menopause).
Hormone imbalances are often to blame for abnormal uterine bleeding. They’re most common among people whose periods are just beginning or near ending.
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Symptoms of abnormal uterine bleeding
Some clues your bleeding is out of the ordinary and you might be experiencing menometrorrhagia include:
- soaking through tampons or sanitary pads every hour for several hours
- bleeding longer than eight days
- bleeding outside your usual menstrual cycle
- passing large blood clots
- having back and abdominal pain during menstruation
- feeling tired, weak, or short of breath, which may be signs that the excessive bleeding has reduced the amount of iron in your blood, leading to anemia
There’s no concrete medical definition of “abnormal” uterine bleeding. For the average woman, menstruation occurs every 28 days, though having a period every 21-35 days is considered normal. The average length of a menstrual cycle is about 5 days. Most women will lose less than 80 ml, or 3 ounces, of blood overall.
Most experts agree that any bleeding that’s so excessive and severe that it interferes with your physical, social, and emotional life is abnormal.
You can also read about symptoms and causes of preeclampsia.
Causes of abnormal uterine bleeding
Abnormal uterine bleeding can have many causes, including a variety of medical conditions and even stress:
- Hormone imbalances
- Pre-cancer and cancer
- Structural abnormalities in your uterus
- Viral, bacteria or fungi infections
- Medications
- Other medical conditions
- Retained foreign bodies and trauma
Hormone imbalance
- Anovulation.
- Thyroid disease.
- Polycystic ovary syndrome (PCOS).
Having obesity or being overweight can lead to hormone imbalances that may cause abnormal uterine bleeding, too.
Pre-cancer and cancer
- Uterine cancer.
- Cervical cancer.
- Vaginal cancer.
- Ovarian cancer.
- Endometrial hyperplasia.
Structural abnormalities in your uterus
- Polyps.
- Fibroids.
- Adenomyosis.
Viral, bacteria or fungi infections
- Trichomoniasis.
- Cervicitis.
- Chlamydia.
- Gonorrhea.
- Endometritis.
- Vaginitis.
Medications
- Blood thinners and aspirin.
- Hormone replacement therapy.
- Tamoxifen (breast cancer drug).
- Intrauterine devices (IUDs).
- Some Birth control pills and injectables like (NuvaRing®, Depo-Provera®, Implanon®).
Other medical conditions
- Von Willebrand disease.
- Liver disease.
- Kidney disease.
- Pelvic inflammatory disease (PID).
- Leukemia or platelet disorders.
Retained foreign bodies and trauma
- Forgetting to remove an IUD can lead to infection and abnormal bleeding.
- Trauma to your uterus, caused by an injury, can also cause bleeding.
You can also read about causes and prevention of Ectopic pregnancy.
Prevention of abnormal uterine bleeding
You can’t prevent many causes of abnormal uterine bleeding. But you can reduce your risk of certain conditions that lead to abnormal bleeding. For instance:
- maintaining a healthy weight plays a potential role in keeping your hormones balanced.
- Avoiding diets that contain a high amount of animal fat can reduce your risk of some cancers.
- Practicing safer sex can reduce your risk of certain sexually transmitted infections (STIs) that can cause abnormal uterine bleeding.
Diagnosis of abnormal uterine bleeding
Doctors check these things when diagnosing abnormal uterine bleeding:
- How often you get your period. It should be fairly regular. The length of each cycle shouldn’t change by more than a week. If it’s shorter than 3 weeks or longer than 5, that could be a sign of a problem.
- How long it lasts. A typical period lasts 4 or 5 days. If yours is often less than 2 days or longer than a week, that could mean something’s wrong.
- How heavy it is. Most women only lose about 2 tablespoons of blood each period. More than 5 tablespoons is thought to be unusually heavy, but that’s hard to judge. Let your doctor know if you need more than one tampon or pad in an hour. Abnormally heavy menstrual bleeding is called menorrhagia.
- Whether you have spotting between periods.
- Whether you have bleeding after sex.
Your doctor will test for disorders that can cause abnormal uterine bleeding (menometrorrhagia). This tests can include:
- A blood test. This will be used to test for pregnancy. That’s because miscarriage, even when it occurs before you know you’re pregnant, can cause heavy bleeding. You can still test positive for pregnancy up to 35 days after a miscarriage. Also your provider can check how your blood clots and do a complete blood count.
- Ultrasound. This uses sound waves to make images of the inside of your uterus so your doctor can look for fibroids or polyps.
- Hysteroscopy. The doctor will look inside your uterus with a tiny lighted scope that they put in through your cervix.
- Biopsy. The doctor may take out a small piece of tissue and check it under a microscope for abnormal cells.
- Magnetic resonance imaging. This test uses radio waves and powerful magnets to make detailed pictures of your uterus. It isn’t used that often, but it can help spot adenomyosis.
Complications of abnormal uterine bleeding
- Excessive menstrual bleeding can have a significant impact on your health and quality of life. The significant loss of blood can lead to anemia. Anemia is a condition in which your blood is lacking oxygen-carrying red blood cells. Without oxygen-rich blood, you may feel weak and tired.
- Excessive menstrual bleeding can also be a symptom of some reproductive cancers and conditions that affect fertility. It’s important to get medical attention when you experience any excessive bleeding.
Treatment of abnormal uterine bleeding
Treatment of abnormal uterine bleeding depends on what’s causing the bleeding. Medications and procedure options are available to manage bleeding or treat what’s causing it.
Medications used to treat abnormal uterine bleeding (Menometrorrhagia) include:
- Gonadotropin-releasing hormone (GnRH) agonists can temporarily stop or reduce bleeding by preventing ovulation.
- Birth control pills.
- Progestin (can be given by a shot, implant or device placed in your uterus called an IUD).
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
- Gonadotropin-releasing hormone (GnRH) antagonists can manage heavy period bleeding related to fibroids.
There are several procedures available to treat abnormal uterine bleeding. Ask your provider about how often they perform a given procedure. Seeing a provider who frequently performs a procedure often leads to faster recovery with fewer complications. This can include:
- Uterine artery embolization. Stops blood flow to fibroids, causing them to shrink.
- Hysteroscopy. A procedure where your provider removes atypical structures in your uterus, like fibroids and polyps.
- Myomectomy. Removes fibroids while keeping your uterus intact and preserving your ability to get pregnant and have children.
- Endometrial ablation. Destroys your uterus lining through the use of a laser, heat, electricity, microwave energy or freezing. You shouldn’t have this procedure if you want to get pregnant and have children.
- Hysterectomy. Removes your uterus. Hysterectomy is often used to treat cancer or cancerous changes in your endometrium. Advanced stages of cancer may need radiation or chemotherapy.
With some of the underlying causes of abnormal uterine bleeding can affect fertility, but many women can go on to get pregnant and successfully deliver babies following proper treatment or surgical procedures like Uterine artery embolization or Myomectomy.
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