Causes of Abnormally Heavy or Prolonged Menstrual Bleeding

There are several causes for menorrhagia, and it is important to determine the underlying cause for the condition. If you experience abnormally heavy and/or prolonged menstrual periods, contact your health care provider. He or she may ask you to keep a menstruation calendar (log that contains details about your menstrual cycle).

Determining the cause for atypical bleeding may involve taking a medical and family history (including menstrual history) and performing a complete physical examination and diagnostic tests. Laboratory and imaging tests that may be used to diagnose the underlying cause for menorrhagia include complete blood count (CBC), thyroid function test, Pap smear, and pelvic ultrasound. In some cases, a surgical procedure (e.g., endometrial biopsy, hysteroscopy) also may be necessary.

Conditions that can cause menorrhagia include the following:

  • Adenomyosis and endometriosis (disorders of the lining of the uterus)
  • Blood disorder (e.g., von Willebrand's disease, which is the most common inherited bleeding disorder in Caucasians)
  • Certain anti-inflammatory, anticoagulant, or antiplatelet medications (e.g., aspirin, steroids, warfarin [Coumadin, Jantoven, Marfarin], clopidogrel [Plavix])
  • Diabetes or other endocrine disorder (e.g., thyroid disease, hypothyroidism)
  • Hypertension (high blood pressure) or heart disease
  • Hormone imbalance (e.g., caused by oral contraceptives, hormone replacement therapy [HRT], stress, poor nutrition)
  • Inflammation of the fallopian tube (salpingitis), uterus (metritis), or uterine lining (endometritis)
  • Kidney disease (e.g., chronic nephritis, Wilms' tumor)
  • Leukemia
  • Liver disease
  • Lupus (systemic lupus erythematosus [SLE])
  • Pelvic inflammatory disease (PID; infection in the reproductive system)
  • Pelvic injury or trauma
  • Polycystic ovary syndrome (PCOS)
  • Pregnancy complications, such as miscarriage or ectopic pregnancy (implantation of a fertilized egg outside of the uterus)
  • Use of an IUD (intrauterine device) as a form of contraception
  • Uterine polyps or fibroids (non-cancerous growths in the uterus or uterine lining), cancer of the reproductive tract, or uterine abnormalities (e.g., "tipped" uterus)

Publication Review By: the Editorial Staff at

Published: 05 Jan 2011

Last Modified: 28 Jan 2015