Menorrhagia in Adenomyosis

Menorrhagia refers to excessive blood loss due to prolonged menstrual bleeding and/or extremely heavy bleeding.

McCausland (1992) and Levgur (2000) both correlated excessive blood loss to the depth of invasion of adenomyosis into the myometrium (uterine muscle). Pistofidis (2014) found menorrhagia more common in the diffuse type of adenomyosis as compared to the sclerotic or nodular form of the disease. Li et al. (2018) found that patients with both adenomyosis and endometriosis had a higher rate of menorrhagia (78.8%) compared to those with adenomyosis only (61.2%).

Causes of menorrhagia include increased vascularization of the uterine wall, uterine hyperperistalsis and dysperistalsis, increased size of the uterus, and increased levels of estrogen, eicosanoids, and prostaglandins.

In my most recent book, Adenomyosis: The Women Speak, I asked women in the Adenomyosis Fighters Support Group to describe their levels of bleeding during menstruation. Here are a few of the most memorable responses:

“It’s like a Quentin Tarantino movie.”

“Period has been continuous for 5 years.”

“Twenty-five to 30 pads a day.”

“I must sit on a black towel for a minimum of two days a month, and I still have problems. I cannot leave the house at these times.”

“Normally 5 days, but for the last 3 months, they’ve been lasting 3-4 weeks at a time with only a day or two without bleeding.”

“Most recently, 12 days and going strong.”

“It’s constant, even if just spotting.”