I. Introduction
As we mentioned in previous articles menstruation is the shedding of the uterine lining. It is normal to the reproductive system of women and happens on a regular basis. Normal menstruation happens around 3 to 7 days. During the monthly menstrual cycle, female sex hormones prepare the uterus to support a pregnancy. If pregnancy happens, menstruation will be suspended until giving birth of a child, abortion, or miscarriage. Otherwise the uterine lining sheds and menstrual blood, tissues, fluid and mucus leave the body through the vagina caused by natural reaction in the female reproductive system from low levels of certain growth hormones.

II. Menorrhagia
As we mention in the previous article, the last stage of the menstrual cycle is the shedding of an endometrial lining's blood vessels. Normally,the process of blood forming clots occurs(coagulation) to limit and repair the damaged blood vessel resulting in a stoppage of blood flow. Menorrhagia is an abnormally heavy and prolonged menstrual period with excessive menstrual bleeding lasting longer than 7 days or blood loss exceeding 80 ml caused by abnormal blood clotting, disruption of normal hormonal regulation of periods, or disorders of the endometrial lining of the uterus.
Since normal menstrual cycle about 28 days in duration, with bleeding lasting an average of total blood loss less than 80 mL, women with menorrhagia over the menstruation may have blood loss greater than the body's iron reserves and reproduced by the body leading to anemia.

III. Causes
1. Stress
Women whp cannot adjust to events in life that are stressful, or seem to be stressful in their mind causes hormone imbalance resulting in overproduction of either estrogen or progesterone.
2. Hormone imbalance
For whatever reason, heavy blood flow may also occur for most women.
3. Vitamin K deficiency
Vitamin K is blood coagulation. Normally produced by bacteria in the intestine, women with intestine diseases may not produce enough vitamin K to stop the heavy flowing of blood during menstruation.
4. Anemia
Women with the type of anemia having red blood cells breaking down faster than normal people, may also have heavy flowing of blood during menstruation caused by regular blood flow and breaking off of red blood cells thereby, reducing the coagulation function.
5. Perimenopause
Women in the perimenopause normally have higher levels of estrogen levels and lower levels of progesterone because ovulation is less consistent.

IV. Symptoms
1. Spotting or bleeding between menstrual periods
2. Excessive menstrual bleeding
3. Heavy period
4. Symptoms of anemia (caused by loss of iron in the blood)
5. Constant pain in the lower abdomen during menstrual period
6. Irregular menstrual periods

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