From your first period, you’ll need to find a means of controlling heavy menstrual bleeding that meets your preferences, potentially including a pad, a tampon, or a menstrual cup. You’ll need to keep it accessible when your period is getting close, as well as some extra pants readily available in the event of a surprisingly heavy flow. Some women may also need to keep some pain relief medication on hand to reduce cramps and other uncomfortable symptoms.

Unfortunately, there is a population of women that will experience a consistently heavy flow beyond that experienced by most women, diagnosed as menorrhagia (heavy menstrual bleeding. An abnormally heavy flow should be evaluated by a healthcare professional to determine the underlying cause. Potential causes include polyps, fibroids, hormone imbalance, adenomyosis, and von Willebrand’s disease.

Is Heavy Menstrual Bleeding Serious?

Heavy menstrual bleeding can affect your daily life, hindering you from accomplishing the tasks you have for the day. As mentioned, severe blood loss can also cause symptoms of anemia, a medical condition that develops when you have too little iron in your body. This depletion of iron can be life-threatening without corrective treatment.

Even if you do not develop anemia, it is still important to see a healthcare professional about menorrhagia. Some of the underlying causes of heavy bleeding, including cancer, require early medical intervention. So, although heavy bleeding may affect anywhere from 27% to 54% of people who menstruate, its common nature should not override the severity.

What is Menorrhagia?

There is a significant difference between normal menstrual bleeding and menorrhagia, or heavy menstrual bleeding. Though any large amount of bleeding is a concern, most women will not experience heavy enough or prolonged enough bleeding to be considered menorrhagia. The bleeding must be severe enough that you cannot maintain your usual activities during your period due to blood loss and cramping.

Signs and symptoms of menorrhagia include:

• A flow heavy enough to soak through one or more sanitary pads or tampons every hour for three or more consecutive hours.
• The need to use double sanitary protection to contain your menstrual flow.
• Waking up in the middle of the night to change your sanitary protection.
• Periods lasting for a week or longer.
• Passing blood clots that are a quarter size or bigger. The blood may be pink, red, brown, or rust-like in color.
• Losing more than 80 milliliters of blood during your period, compared to the typical 35-40 milliliters lost by most women.
• Restricting your daily activities because of the heavy menstrual flow.
• Anemia symptoms like fatigue, tiredness, or shortness of breath.

Along with anemia, you could also notice symptoms of a condition called pica. These symptoms include pale skin, hair loss, and the urge to eat non-food items (hair, paper, dirt, and more). Contacting your provider is important if you experience any of these symptoms.

How Do I Know If I Have Menorrhagia?

Unfortunately, many people that experience heavy menstrual bleeding do not get medical help because they assume their periods are supposed to be uncomfortable and inconvenient. Their concerns may have been dismissed by family members that experience similar symptoms or even healthcare providers that did not take their concerns seriously. However, your flow should never require you to accept inconvenience or restrict activities long-term.

During your period, you should be able to:

• Wear a standard absorbency pad or tampon for three to four hours without changing it for a new one.
• Wear a single sanitary product without needing to double up (two pads or two tampons at the same time) at any point.
• Leave your home for a few hours without planning to bring extra bags of pads or clothing changes.
• Live your life as you normally do, without avoiding public places or missing work.

If your period is disrupting your life, it is time to visit your healthcare provider and start working on a plan to find and treat the cause.

What is the Cause of a Heavy Menstrual Bleeding?

Heavy menstrual bleeding can be caused by many different conditions, ranging from hormone imbalances to medical conditions and even stress.

Hormone Imbalance

Hormones like estrogen and progesterone are produced by your body and regulate your menstrual cycle. If these hormones are not produced in the right amounts at the right time, heavy periods can result. There are medical conditions that will affect your hormones and can cause imbalances that result in heavy menstrual bleeding. These include:

Thyroid Disease

The thyroid gland is wrapped around the trachea in the front of the neck. It makes and stores hormones essential for the function of every cell in the body. Along with the menstrual cycle, these hormones help regulate blood pressure, heart rate, body temperature, and how food is converted to energy. Thyroid disease is a general term used when the thyroid fails to make the proper level of hormones, whether it is too much (hyperthyroidism) or too little (hypothyroidism). The cause of the disease will dictate treatment, but it can include medication, surgery, and radioactive iodine.

Anovulation

Anovulation occurs when an ovum, or egg, fails to release from your ovary during your menstrual cycle. It is a common cause of infertility, as an egg is required for pregnancy. A build-up of the uterine lining and insufficient levels of progesterone from anovulation can cause heavy bleeding. Treatment for this condition depends on your specific hormone imbalance but can include managing your stress, medication, and hormone injections.

Polycystic Ovary Syndrome (PCOS)

PCOS is a hormonal disorder that is common among women of reproductive age. It is caused by the ovarian overproduction of androgens; male sex hormones typically present in women in small amounts. This disorder is normally characterized by fluid-filled sacs that form on the ovaries if the ovary fails to release an egg.

Treatment depends on whether you want to become pregnant or not. If you do want to become pregnant, treatment options include medication to induce ovulation and surgery. Birth control is a common treatment for those that do not want to become pregnant.

Infection

Some infections, including sexually transmitted infections (STI), can result in heavy menstrual bleeding.

Chlamydia

Caused by an infection of a bacteria called Chlamydia trachomatis, chlamydia is an STI that can cause heavy menstrual cycles. It can also cause inflammation of the cervix, which results in spotting between periods. Chlamydia is treated with antibiotics.

Gonorrhea

Gonorrhea is caused by an infection of the bacteria Neisseria gonorrhoeae and is commonly a co-infection with chlamydia. Like chlamydia, it can also cause irritation of the cervix that results in bleeding in between cycles. Gonorrhea is also treated with antibiotics.

Chronic Endometriosis

Though the exact cause of endometriosis is unknown, it is believed to be retrograde menstruation, where menstruation blood flows from the uterus back through the fallopian tubes and into the pelvic cavity. This condition can cause very heavy or very light menstrual flow. Endometriosis is treated with hormone therapy, surgical treatments, and pain medications.

Noncancerous Growths in the Uterus

Even though these growths are benign and noncancerous, they can still cause cells to grow improperly in your uterus, which can result in heavy menstrual bleeding.

Polyps

Uterine polyps, or endometrial polyps, are growths in the inner lining of the uterus (endometrium). The polyps are caused by an overgrowth of endometrial tissue, may be round or oval, and can range from a few millimeters to a few centimeters. Polyps can cause your menstrual cycle to become irregular or heavy. Treatment for polyps depends on their location and size, but they are frequently surgically removed.

Uterine Fibroids

Uterine fibroids, also termed leiomyomas, are growths composed of connective and muscle tissue from the wall of the uterus. They are rounded growths that can grow as a single nodule or in a cluster. They can cause painful and excessive menstrual bleeding. There are many treatments for fibroids, including medication and surgical removal, but they can also be left in place if they are nonsymptomatic.

Adenomyosis

Adenomyosis occurs when tissue from the endometrium grows and pushes into the uterine wall, enlarging the uterus. The uterus can grow to double or triple the normal size because of the extra tissue. The enlarged uterus will then cause abnormally high blood volume during your period. Pain medication, hormonal birth control, and a hysterectomy are treatment options for adenomyosis.

Uterine Cancer

Heavy menstrual bleeding can be caused by cancers of the reproductive system. Uterine cancer is a general term that covers all cancers of the uterus, including endometrial cancer and uterine sarcoma. About 3% of cisgender women will be diagnosed with uterine cancer, and of these, most will develop endometrial cancer. Treatment for uterine cancer is typically a hysterectomy to remove all the cancerous tissue.

Heavy Menstrual Bleeding and Other Medical Conditions

Heavy menstrual bleeding can be a symptom of various medical conditions, including non-bleeding disorders and bleeding disorders.

Von Willebrand Disease

This common blood disorder is genetically inherited and prevents your blood from clotting properly. It is like hemophilia, but it usually causes less severe symptoms. The condition may be treated with medication, specifically birth control, to help reduce the blood loss during your period.

Liver Disease

Liver disease refers to any condition that can affect or damage your liver. Because your liver filters out mutated hormones, an improperly functioning liver can cause heavy or clotted menses. Treatment for liver disease depends on the underlying reason for the liver disease and how far it has progressed, but the options include medication, lifestyle changes, and a liver transplant.

How Is the Cause of Heavy Menstrual Bleeding Diagnosed?

The first step to getting a diagnosis is scheduling an appointment with your healthcare provider. You can prepare for this appointment by gathering this information and ensuring the information is thorough.

Questions they may ask during this appointment include:

• What age did you first get your period?
• How long do your periods normally last?
• Do you have family members with a history of heavy menstrual bleeding?
• What birth control are you currently taking, and what is your pregnancy history?
• What other symptoms are you experiencing?
• How are you managing your periods?

Once your provider has gathered your history, they will run a series of tests depending on which conditions are determined to be most likely from your answers.

The possible tests include:

• Blood test
• Pap smear
• Sonohysterogram
• Hysteroscopy
• Endometrial biopsy
• Ultrasound
• Magnetic resonance imaging (MRI)

Menorrhagia FAQs

So, should you speak with your gynecologist about your heavy periods? How can you tell your period is heavy enough to be classified as menorrhagia? Learn more about menorrhagia with these FAQs.

Q: What Does a Normal Period Look Like?

A: There are no strict guidelines for how a period should look because everyone is different. However, while a “normal” period is hard to define, there are general parameters for a typical period. Most cycles last for 28 days, with four to five days of bleeding. The total blood loss should be 35 mL to 40 mL, and the blood clots should be occasional and smaller than a quarter.

Q: What Is Considered a Heavy Menstrual Bleeding?

A: A standard volume of blood loss for a heavy period is 80 milliliters of blood during the period with a duration of seven or more days. If you soak through one or more tampons or pads per hour for several hours or need to wear more than one menstrual product at a time to control the bleeding, you likely have a heavy period.

Q: Should Heavy Menstrual Bleeding Affect My Daily Life?

A: While all people with a period must make a few small accommodations if they want to avoid bleeding on their clothing, your period should not consistently affect your daily life. What’s more, you should not need to schedule your day around your period. If the volume of the bleeding that occurs during your menstrual cycle interferes with your social plans, daily activities, or work life, it is time to see a doctor and find the cause of the bleeding.

Q: What Usually Causes Chronic Heavy Menstrual Bleeding?

A: There is an extensive list of potential causes of excessive uterine bleeding, and a conversation with a healthcare provider may be required to discover the cause of your heavy bleeding. They will be able to administer diagnostic tests and hopefully find answers.

Common culprits are:

• Hormone imbalance
• Bleeding disorders
• Noncancerous growths
• Platelet disorders
• Sexually transmitted infections

You Don’t Have to Settle For the Inconvenience of Heavy Periods

Just because you have lived your life up until now, accepting that heavy periods are normal does not mean you have to continue to do so. Even if your family has convinced you that they are to be endured or previous medical professionals have dismissed your concerns, speaking with trustworthy healthcare providers can result in a diagnosis and treatment plan that completely changes your quality of life.

Sources

1. Menorrhagia (heavy menstrual bleeding) – Symptoms and causes – Mayo Clinic
2. Heavy Menstrual Bleeding (Menorrhagia): Causes & Treatment (clevelandclinic.org)
3. Polycystic Ovary Syndrome (PCOS) | Johns Hopkins Medicine
4. Anovulation: Signs, Symptoms, Causes & Treatment (clevelandclinic.org)
5. Uterine Polyps: Causes, Symptoms, Diagnosis & Treatment (clevelandclinic.org)
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500811/

Dr. Kelly Roy, MD

Founder and Medical Director of ARIZONA GYNECOLOGY CONSULTANTS

Dr. Kelly Roy is a specialist in surgical gynecology and advanced laparoscopy (and hysteroscopy). She is a long-time resident of Arizona and obtained her Bachelor of Science degree in Biomedical Engineering at Arizona State University before finishing her Doctorate of Medicine at the University of Arizona in 1997.

Dr. Roy completed her residency in Obstetrics and Gynecology at the then “Banner Good Samaritan Hospital” (now Banner University Medical Center), in Phoenix Arizona in 2001.

Well known for her teaching and surgical ability, she is on the faculty at the residency program at both Banner University Medical Center and Saint Joseph’s Hospital in central Phoenix and is a Clinical Assistant Professor of Medicine at the University of Arizona College of Medicine, Phoenix Campus. Dr. Roy has taught advanced surgical techniques to medical students, residents, fellows and colleagues for over 15 years.

Dr. Roy is also a consultant to the medical device industry and has participated in the design and clinical testing of many instruments and surgical devices available on the world-wide market today.

Read More About Dr. Kelly Roy, MD   |   WebMD Profile   |   Health.USNews.com Profile |  Current Obstetrics and Gynecology Reports: TFA with the Sonata System