Menorrhagia, defined as excessively heavy or prolonged bleeding during menstruation, has multiple causes. Hormonal imbalances (particularly estrogen-progesterone imbalance) can cause the uterine lining to overgrow. Structural causes include uterine fibroids, polyps, adenomyosis (where uterine lining grows into the muscle wall), and endometriosis. These conditions often coexist and can be hormonally influenced while causing mechanical changes that worsen bleeding. Heavy bleeding is frequently accompanied by severe cramping and can lead to anemia and fatigue. If you experience sudden, very heavy bleeding, symptoms of dizziness, or bleeding that significantly impacts your daily life, seek medical attention immediately.