All of us, from time to time, experience what we feel is unusually heavy bleeding during our menstrual periods. Fortunately, most often what we think is abnormal uterine bleeding is not excessive enough to be diagnosed as menorrhagia. How do you know when bleeding during your period is abnormally heavy? The easiest way to know if you are experiencing menorrhagia is to take note of how often you need to change your pad or tampon. If your period is heavy enough to require changing more often than every one or two hours, or if you have a period that lasts more than a full week, you may be experiencing menorrhagia. Let’s take a look at the most common causes of menorrhagia or heavy menstrual bleeding: # A hormonal imbalance during adolescence or menopause is the most common cause of heavy menstrual bleeding. During adolescence, after girls have their first periods, and for several years before the onset of menopause when menstruation ceases, our hormones levels are fluctuating which often leads to excessive uterine bleeding during our periods. It’s often possible to treat menorrhagia caused by hormonal imbalances with birth control pills or other hormones. # Uterine fibroid tumors are another very common cause of excessive menstruation. It’s important to understand that fibroid tumors are usually benign (non-cancerous) tumors that often occur in the uterus of women during their thirties or forties. While the cause of uterine fibroid tumors is unclear, it is clear that they are estrogen-dependent. Several surgical treatments are available for treating fibroid tumors of the uterus including myomectomy, endometrial ablation, uterine artery embalization, and uterine balloon therapy, as well as hysterectomy. Non-surgical pharmacological treatments for fibroid tumors include GnRH agonists, oral contraceptives, androgens, RU486 (the abortion pill), and gestrinone. Some women find natural progesterone to be an effective treatment for uterine fibroid tumors. Often, when symptoms are not severe or troublesome, a “wait and see” approach is taken. Once menopause occurs, uterine fibroid tumors typically shrink and disappear without treatment. # Cervical polyps are small, fragile growths that begin in either the mucosal surface of the cervix, or the endocervical canal and protrude through the opening of the cervix. The cause of cervical polyps is not clear; however, they are often the result of an infection and many times associated with an abnormal response to increased estrogen levels or congestion of the blood vessels located in the cervix. Women most commonly affected by cervical polyps are those over the age of twenty who have had children. A simple out patient office procedure that removes the growth, along with antibiotics, is the usual treatment for cervical polyps. # Endometrial polyps are typically non-cancerous, growths that protrude from the lining of the uterus. The cause of endometrial polyps is unclear, although they are often associated with an excess of estrogen following hormone treatment or some types of ovarian tumors. Treatments for endometrial polyps include hysteroscopy and D&C. A pathology lab will evaluate endometrial polyps for cancer following removal. # Lupus is a chronic inflammatory, and autoimmune disease that affects several parts of the body, particularly the skin, joints, blood, and kidneys. The cause of lupus is unclear; however, it’s believed that patients have a genetic predisposition to Lupus and scientists know that environmental factors such as infections, certain types of antibiotics -- particularly sulpha and penicillin drugs, UV light, severe stress, hormones and certain other drugs play a key role in triggering disease symptoms. The symptoms of Lupus vary widely among patients, as do the treatments which range from avoiding stress to drugs such as non-steroidal anti-inflammatory medications or NSAIDS, acetaminophen, steroids, antimalarials, cytoxic or immunosuppressive drugs, and anticoagulants.