menorrhagia
Summary
Heavy or prolonged menstrual bleeding (>80 mL/cycle or >7 days). Common causes include fibroids, adenomyosis, endometrial polyps/hyperplasia, von Willebrand disease, and anovulation; classic complication is iron-deficiency anemia.
Detail
Menorrhagia is heavy regular menstrual bleeding, distinguished from metrorrhagia (irregular bleeding between cycles) and menometrorrhagia (heavy + irregular). The PALM-COEIN framework categorizes causes: structural (Polyp, Adenomyosis, Leiomyoma, Malignancy) and nonstructural (Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified). Adolescents with menorrhagia at menarche should be screened for von Willebrand disease (most common inherited bleeding disorder). Workup: CBC, ferritin, TSH, pregnancy test, coagulation studies, pelvic US, and endometrial biopsy if >45 years or risk factors for hyperplasia/cancer. Management: NSAIDs, tranexamic acid, combined OCPs, levonorgestrel IUD (very effective), GnRH analogs, or surgery (ablation, hysterectomy).
Sources
- First Aid for USMLE Step 1 2024
- UpToDate
- ACOG Guidelines
Reviewed by AnkiBoss editorial — medical student review. Information here is for study reference only and is not medical advice. Spotted an error? Let us know.