Heavy menstrual bleeding is common among pre-menopausal women. But if it's too severe, then it's time you consulted your Gynaecologist. Menstrual periods, in which bleeding is abnormally heavy or are prolonged, is medically called Menorrhagia. It is a common concern among premenopausal women. Menorrhagia causes enough blood loss and cramping during your periods as a result of which you can't maintain your usual activities. Causes In some cases, the cause of heavy menstrual bleeding is unknown; but a number of conditions may cause menorrhagia. Hormonal imbalance: If a hormonal imbalance occurs, the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding.  Dysfunction of the ovaries: If ovulation does not occur in a menstrual cycle (anovulation), progesterone is not produced. This causes hormonal imbalance and may result in menorrhagia. Uterine fibroids: These non-cancerous tumours of the uterus appear during your childbearing years. Uterine fibroids may cause heavier than normal or prolonged menstrual bleeding.   Polyps: Small, benign growths on the lining of the uterine wall (uterine polyps) may cause heavy or prolonged menstrual bleeding. This commonly occurs in women of reproductive age. Adenomyosis: This condition occurs when glands from the endometrium become embedded in the uterine muscle, often causing heavy bleeding. Pregnancy complications: A single, heavy, late period may be due to a miscarriage. An ectopic pregnancy may also cause menorrhagia. Cancer: Rarely, uterine cancer, ovarian cancer and cervical cancer can cause excessive menstrual bleeding and going for a blood test for cancer is a good idea.  Risk-factors Iron deficiency or anaemia: Menorrhagia may deplete iron levels enough to increase the risk of iron deficiency or anaemia. Severe pain: Heavy menstrual bleeding often is accompanied by painful menstrual cramps. Tests and diagnosis Your doctor will most likely ask about your medical history and menstrual cycles. She will do a physical examination and may recommend one or more tests or procedures such as: Blood tests: A sample of your blood is evaluated in case excessive blood loss during menstruation has made you anaemic. Tests may also be done to check for thyroid disorders or blood-clotting abnormalities. Pap test: Your doctor collects cells from your cervix for microscopic examination to detect infection, inflammation or changes that may be cancerous or may lead to cancer. Endometrial biopsy : Your doctor may take a sample of tissue from the inside of your uterus to be examined under a microscope. Ultrasound scan: This imaging method uses sound waves to produce images of your uterus, ovaries and pelvis. Based on the results of your initial tests, your doctor may recommend further testing. Treatment & drugs When menorrhagia is a sign of another condition, such as thyroid disease, treating that condition usually results in lighter periods. Specific treatment for menorrhagia is based on a number of factors, including

• Your overall health and medical history
• The cause and severity of the condition
• Your tolerance for specific medications, procedures or therapies
• The likelihood that your periods will become less heavy soon
• Your future childbearing plans
• Effects of the condition on your lifestyle
• Your opinion or personal preference

Drug therapy for menorrhagia may include… Iron supplements. If the condition is accompanied by anaemia, your doctor may recommend that you take iron supplements regularly. Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen, may help reduce menstrual blood loss. NSAIDs have the added benefit of relieving painful menstrual cramps. Oral contraceptives. Aside from providing effective birth control, oral contraceptives can help regulate menstrual cycles and reduce episodes of excessive bleeding. Oral progesterone. When taken for 10 or more days of each menstrual cycle, the hormone progesterone can help correct reduce menorrhagia. You may need surgical treatment for menorrhagia if drug therapy is unsuccessful. Treatment options include Dilation and curettage (D&C), Operative hysteroscopy, Endometrial ablation, Endometrial resection and Hysterectomy. Except for hysterectomy, these surgical procedures are usually done on an outpatient basis. Although you may need a general anaesthetic, it's likely that you can go home later on the same day. Take advice If your periods are so heavy that they limit your lifestyle, make an appointment with your doctor. Seek medical help if you experience Vaginal bleeding so heavy it soaks at least one pad or tampon an hour for more than a few hours irregular vaginal bleeding or any vaginal bleeding after menopause