Menstrual Flow/Bleeding

What Causes Heavy Menstrual Bleeding?

Heavy menstrual bleeding can have various causes, ranging in severity from 'worrying' to 'very serious'.  Finding the true cause means ruling out or confirming each possibility – in other words, diagnosis.

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Diagnosis is usually a complex process due to the sheer number of possible causes and related symptoms.  In order to diagnose heavy menstrual bleeding, we could:

  • Research the topic
  • Find a doctor with the time
  • Use a diagnostic computer system.
The process is the same, whichever method is used.

Step 1: List all Possible Causes

We begin by identifying the disease conditions which have "heavy menstrual bleeding" as a symptom.  Here are eight possibilities (more below):
  • Endometrial Hyperplasia
  • A Weight Problem
  • Endometriosis
  • Hypothyroidism
  • Fibroids
  • Low Progesterone
  • Vitamin A Need
  • Bleeding Tendency

Step 2: Build a Symptom Checklist

We then identify all possible symptoms and risk factors of each possible cause, and check the ones that apply:
joint pain/swelling/stiffness
occasionally feeling unusually cold
hypothyroidism in family members
premenstrual abdominal bloating
omnivorous diet
painful menstrual cramps
low progesterone level
history of adult allergies
being highly lethargic
having low TT4 level
angry/hostile disposition
significant abdominal distension
... and more than 90 others

Step 3: Rule Out or Confirm each Possible Cause

A differential diagnosis of your symptoms and risk factors finds the likely cause of heavy menstrual bleeding:
Cause Probability Status
A Weight Problem 98% Confirm
Fibroids 19% Unlikely
Endometrial Hyperplasia 15% Unlikely
Low Progesterone 2% Ruled out
Vitamin A Need 0% Ruled out
Hypothyroidism 0% Ruled out
Endometriosis 0% Ruled out
Bleeding Tendency 0% Ruled out
* This is a simple example to illustrate the process

Arriving at a Correct Diagnosis

The Analyst™ is our online diagnosis tool that learns all about you through a straightforward process of multi-level questioning, providing diagnosis at the end.

If you indicate being premenopausal or being perimenopausal, The Analyst™ will ask further questions including this one:
How would you rate your average menstrual bleeding?
Possible responses:
→ Don't know
→ Light
→ Normal / average
→ Heavy
→ Very heavy
Based on your response to this question, which may indicate having light periods, having average menstrual bleeding or having heavy periods, The Analyst™ will consider possibilities such as:

Fibroids can lead to heavier bleeding during periods.


Prolonged and/or heavy periods are a sign of hypothyroidism.

Progesterone Low or Estrogen Dominance

In a normal menstrual cycle, estrogen and progesterone regulate the buildup of the endometrium (uterine lining of blood and tissue), which is shed each month during menstruation.  Menorrhagia can occur because of an imbalance between estrogen and progesterone.  As a result of the imbalance, the endometrium keeps building up resulting in heavy bleeding when it is eventually shed.  Since hormone imbalances are often present in adolescents and in women approaching menopause, this type of menorrhagia (dysfunctional uterine bleeding) is fairly common in these groups.

Vitamin A Requirement

One study found serum retinol levels (a measure of vitamin A levels) to be significantly lower in women with menorrhagia than in healthy controls.  92% of those with lower levels experienced either complete relief or significant improvement after 25,000 IU of vitamin A was taken twice per day for 15 days.

Problems Caused By Being Overweight

Chronic menorrhagia and PMS is usually the result of deficient progesterone secretion or constant adipose-released estradiol from obesity or recent substantial weight loss.

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