The medical term for heavy menstrual bleeding with abnormal heavy or prolonged bleeding is menorrhagia. The heavy menstrual bleeding is a common concern but most women do not experience blood loss severe enough to be defined as heavy menstrual bleeding. When women have this condition, then they cannot maintain their usually activities because they have so much blood and cramping.  If you dread your periods because you have menorrhagia, then you should talk with your doctor. There are many different treatments for heavy menstrual bleeding.
Symptoms of heavy menstrual bleeding 
- Symptoms of anemia, such as tiredness, fatigue or shortness of breath 
- Restricting daily activities due to heavy menstrual flow 
- Passing blood clots larger than a quarter
- Bleeding for longer than a week
- Needing to wake up to change sanitary protection during the night
- Needing to use double sanitary protection to control your menstrual flow
- Soaking through one or more sanitary pads or tampons every hour for several consecutive hours
There are some cases when the cause of heavy menstrual bleeding but there are many different conditions which can lead to menorrhagia. Here are the most common causes for menorrhagia:
- Medications: There are some medications, including anticoagulants such as warfarin (Coumadin and Jantoven) or enoxaparin (Lovenox), hormonal medications such as estrogen and progestins and anti – inflammatory medications can lead to heavy or prolonged menstrual bleeding. 
- Inherited bleeding disorders: There are some bleeding disorders which can cause abnormal menstrual bleeding. This is happening with von Willebrand’s disease.  This is a condition in which an important blood – clotting factor is impaired or deficient.
- Cancer: There are some types of cancer, such as cervical cancer and uterine cancer, which can cause excessive menstrual bleeding, especially if you have postmenopausal or have had an abnormal Pap test in the past.
- Pregnancy complications: A single, heavy and late period can be due to miscarriage. The unusual location of the placenta such as low – lying placenta or placenta previa is another cause for the heavy menstrual bleeding. 
- Intrauterine device (IUD): Menorrhagia can be a side effect of using nonhormonal intrauterine device for birth control. Your doctor will tell you what you should do for alternative management options. 
- Adenomyosis: Adenomyosis is happening when the glands from the endometrium become embedded in the uterine muscle which is often causing heavy bleeding and painful periods. 
- Polyps: Small and benign growths on the lining of the uterus (uterine polyps) may cause prolonged or heavy menstrual bleeding. 
- Uterine fibroids: These are noncancerous tumors, also called benign tumors, of the uterus are appearing during your childbirth years. The uterine fibroids may cause heavier than normal or prolonged menstrual bleeding. [8,9]
- Dysfunction of the ovaries: If your ovaries do not release an egg (ovulate) during a menstrual cycle (anovulation), then your body does not produce the hormone progesterone as it would do during the normal menstrual cycle. This can lead to hormone imbalance and it can result in menorrhagia. 
- Hormone imbalance: In a normal menstrual cycle, the balance between the hormones estrogen and progesterone regulates the buildup of the lining of the uterus (endometrium) which is shed during the menstruation. If the hormone imbalance happens, then the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding. There are many different conditions which can cause hormone imbalances such as thyroid problems, insulin resistance and PCOS (polycystic ovary syndrome). 
- Other medical conditions: There are many different conditions such as kidney or liver disease which can be associated with menorrhagia.
Risk factors: Risk factors vary with age and whether you have other medical condition which can explain the heavy menstrual bleeding. When there is a normal cycle, then the release of an egg from the ovaries stimulates the body’s production of progesterone which is a female hormone most responsible for keeping periods regular. When no egg is released, then the insufficient progesterone can lead to menorrhagia.
 Gokyildiz S, Aslan E, Beji NK, Mecdi M. The effects of menorrhagia on women’s quality of life: A case-control study. International Scholarly Research Notices. 2013. Retrieved from hindawi.com/journals/isrn/2013/918179/
 Kocaoz S, Cirpan R, Degirmencioglu AZ. The prevalence and impacts heavy menstrual bleeding on anemia, fatigue and quality of life in women of reproductive age. Pakistan Journal of Medical Sciences. 2019;35(2):365–70.
 Boonyawat K, O’Brien SH, Bates SM. How I treat heavy menstrual bleeding associated with anticoagulants. Blood. 2017;130(24):2603–9.
 Ragni MV, Machin N, Malec LM, et al. Von Willebrand factor for menorrhagia: A survey and literature review. Haemophilia. 2016;22(3):397–402.
 Peyvandi F, Garagiola I, Menegatti M. Gynecological and obstetrical manifestations of inherited bleeding disorders in women. Journal of Thrombosis and Haemostasis. 2011;9(1):236-45.
 Toppozada M. Treatment of increased menstrual blood loss in iud users. Contraception. 1987;36(1):145-57.
 Vannuccini S, Petraglia F. Recent advances in understanding and managing adenomyosis. Version 1. F1000Res. 2019;8:F1000 Faculty Rev-283.
 Hapangama DK, Bulmer JN. Pathophysiology of heavy menstrual bleeding. Womens Health. 2016;12(1):3–13.
 Beebeejaun Y, Varma R. Heavy menstrual flow: Current and future trends in management. Reviews in Obstetrics and Gynecology. 2013;6(3-4):155–64.
 Hickey M, Karthigasu K, Agarwal S. Abnormal Uterine Bleeding: a Focus on Polycystic Ovary Syndrome. Women’s Health. 2009;5(3):313-24.