INTRODUCTION

Chronic heavy or prolonged uterine bleeding is a common gynecologic problem. Such bleeding may be ovulatory or anovulatory. Chronic heavy or prolonged uterine bleeding can result in anemia, interfere with daily activities, and raise concerns about uterine cancer. Most women with heavy or prolonged uterine bleeding require medical attention, but can be managed on a nonacute, outpatient basis. Occasionally, uterine bleeding is severe enough to necessitate immediate medical evaluation and treatment.

Chronic heavy or prolonged uterine bleeding in nonpregnant premenopausal women will be reviewed here. Uterine bleeding that requires urgent treatment is discussed separately. (See "Uterine hemorrhage in nonpregnant women".) The general evaluation of abnormal uterine bleeding, menorrhagia in patients with von Willebrand disease, and uterine bleeding in pregnancy are also discussed separately. (See "Terminology and evaluation of abnormal uterine bleeding in premenopausal women" and "Treatment of von Willebrand disease", section on 'Treatment of excessive menstrual bleeding' and "Overview of the etiology and evaluation of vaginal bleeding in pregnant women".)

TERMINOLOGY

The average menstrual cycle lasts up to seven days and the amount of menstrual blood loss is 35 to 40 mL per cycle, but the range is wide [1,2]. Menorrhagia is defined as menstrual blood loss greater than 80 mL. However, the term menorrhagia is applied variably to ovulatory or anovulatory uterine bleeding [3]. In this review, we will refer to heavy menstrual bleeding (>80 mL), and specify ovulatory or anovulatory as necessary.

Prolonged menses are defined as longer than seven days; in this review, we will apply this definition to either ovulatory or anovulatory bleeding and address women with chronic prolonged uterine bleeding.

Management of an isolated episode of prolonged bleeding is discussed separately. (See "Uterine hemorrhage in nonpregnant women".)