Menorrhagia is menstrual bleeding that lasts more than 7 days. How do you know if you have heavy bleeding? If you need to change the tampon or bandage after less than 2 hours, or you are passing clots the size of a quarter palm or more, this is heavy bleeding. Untreated heavy or prolonged bleeding can disrupt normal processes in the body and lead to the development of anemia. Anemia is a common blood problem characterized by fatigue with minimal physical exertion, palpitations, shortness of breath and general weakness. A bleeding problem can in turn lead to other health problems. Possible causes fall into the following three areas: Uterine problems: Uterine growths or tumors that are not malignant, uterine fibroids or polyps; Cancer of the uterus or cervix; Some types of contraceptives – for example, intrauterine pessaries; Pregnancy-related problems, such as miscarriage or ectopic pregnancy, can cause abnormal bleeding. Problems related to hormone levels In a normal menstrual cycle, the balance between the hormones estrogen and progesterone regulates the build-up of the lining of the uterus (endometrium), which is shed during menstruation. If a hormonal imbalance occurs, the endometrium develops in excess and is eventually shed through heavy menstrual bleeding. A number of conditions can cause hormonal imbalance, including polycystic ovary syndrome, obesity, insulin resistance, and thyroid problems. Other bleeding disorders or disorders Bleeding disorders such as von Willebrand disease or platelet dysfunction; Non-bleeding disorders such as liver, kidney or thyroid disease, pelvic inflammatory disease and cancer. In addition, some medications, such as aspirin, can cause heavy bleeding during menstruation. Risk factors vary depending on age and whether there are other accompanying medical conditions that may explain the menorrhagia. In a normal cycle, the release of an egg from the ovaries stimulates the body’s production of progesterone, the female hormone most responsible for keeping menstruation regular. When an egg is not released, insufficient progesterone can cause heavy menstrual bleeding. Menorrhagia in adolescent girls is usually due to anovulation. Adolescent girls are particularly prone to anovulatory cycles in the first year after their first period. Menorrhagia in older women of reproductive age is usually due to uterine pathology, including fibroids, polyps, and adenomyosis. However, other problems, such as uterine cancer, blood clotting disorders, drug side effects, and liver or kidney disease can be contributing factors.The specific treatment of menorrhagia is based on a number of factors and may be medical or surgical. Drug therapy for menorrhagia may include nonsteroidal anti-inflammatory drugs (such as ibuprofen). They have the added benefit of relieving painful menstrual cramps (dysmenorrhea). Oral contraceptives. In addition to providing birth control, oral contraceptives can help regulate the menstrual cycle and reduce episodes of excessive or prolonged menstrual bleeding. Oral progesterone. The hormone progesterone can help correct hormonal imbalances and reduce menorrhagia. Hormonal intrauterine pessaries. This intrauterine device releases a type of progestin called levonorgestrel, which thins the lining of the uterus and reduces menstrual blood flow and cramping. Surgical treatment is started if medication does not give the desired result. It includes dilatation and curettage, uterine artery embolization, myomectomy, or endometrial ablation. References: Menstruation: Heavy Bleeding (Menorrhagia). PreventDisease.com