Unusually long or heavy menstrual bleeding can have several causes. Below is general information on likely reasons, typical assessment steps and when to seek medical care. This is informational and not a substitute for professional evaluation.
Prolonged menstrual bleeding (menorrhagia) can stem from hormonal imbalances, uterine fibroids (myomas), endometrial polyps, endometrial hyperplasia or other changes in the uterine lining, adenomyosis, clotting disorders and thyroid disease. Some contraceptive methods or other medications may alter bleeding patterns. Infections are a less common cause.
Initial evaluation usually includes a medical history (duration and pattern of bleeding, associated pain, medication use, bleeding history) and physical examination. Common investigations may include complete blood count to check for anemia, coagulation tests, thyroid function tests, pelvic ultrasound, cervical screening (Pap smear), and—when indicated—endometrial sampling. The specific tests are selected based on individual history and risk factors.
A gynecologist (Obstetrics & Gynecology) is typically the main specialist for prolonged menstrual bleeding. Primary care physicians or family doctors can provide first‑line assessment and referrals. If a bleeding disorder is suspected, hematology input may be needed; endocrine conditions such as thyroid dysfunction may require endocrinology collaboration.
Seek urgent medical attention if bleeding is so heavy that you feel faint, have shortness of breath, chest palpitations, severe abdominal pain, or symptoms of significant blood loss. These signs warrant immediate emergency evaluation. For ongoing but less severe symptoms, arrange a clinic appointment with your primary care provider or a gynecologist.
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