Having heavy menstrual bleeding, also called menorrhagia, is when a woman loses an excessive amount of blood during her menstrual cycle. The average amount of blood lost during a normal period is around 30-40 milliliters. Heavy periods are defined as losing 80 milliliters or more of blood per cycle.
Quick answers:
- Heavy periods can be caused by hormonal imbalances, uterine fibroids, polyps, adenomyosis, IUDs, and other medical conditions.
- Symptoms include bleeding through a pad or tampon in under 2 hours, passing large blood clots, and periods lasting more than 7 days.
- See your doctor to identify the underlying cause and discuss treatment options like medication, surgery, or hormonal birth control.
- To manage heavy bleeding at home: use extra-absorbent pads/tampons, take NSAIDs for cramps, and maintain an iron-rich diet to prevent anemia.
What are the common causes of heavy menstrual bleeding?
There are several potential causes of abnormally heavy periods:
Hormonal imbalances
Hormonal fluctuations can lead to heavy flows. Conditions like polycystic ovary syndrome (PCOS), thyroid disorders, and low estrogen levels can cause hormone imbalances that affect menstrual cycles.
Uterine fibroids
Noncancerous growths in the uterus called fibroids are a common cause of heavy bleeding. Fibroids can develop inside the uterine wall or protrude into the uterine cavity.
Endometrial polyps
Polyps are benign overgrowths that attach to the inner uterine lining (endometrium). Polyps disrupt normal menstrual blood flow.
Adenomyosis
This condition occurs when the endometrial tissue grows into the muscular walls of the uterus. The displaced tissue thickens the uterus and boosts menstrual flow.
Intrauterine devices (IUDs)
Some women using IUDs for birth control experience heavier, longer periods, especially in the first 3-6 months after insertion. This side effect often improves over time.
Cancer of the uterus, ovaries, or cervix
In rare cases, abnormally heavy bleeding can result from reproductive cancers. See your doctor promptly for evaluation of heavy flows.
Medications
Certain drugs like blood thinners, antidepressants, and chemotherapy agents can sometimes increase menstrual flow.
Pregnancy complications
Miscarriages or ectopic pregnancies may also lead to heavy vaginal bleeding and clotting.
What are the symptoms of heavy menstrual bleeding?
Signs of abnormally heavy periods include:
- Bleeding through a pad or tampon in less than 2 hours
- Needing to change protection during the night
- Passing large blood clots in your flow
- Bleeding that lasts longer than 7 days
- Low iron levels causing fatigue and shortness of breath
- Restricting normal activities due to heavy flow
When to see your doctor
Consult your gynecologist or primary care provider if you experience any of the following:
- Periods so heavy that you become anemic
- Bleeding between periods or after menopause
- Periods lasting longer than 7 days
- Menstrual flow with large clots
- Bleeding that interferes with regular activities
- Pain or cramping during periods
Teen girls who have heavy flows that disrupt school or activities should also be evaluated. Sudden heavy bleeding after having normal cycles can indicate a serious underlying problem requiring prompt medical care.
What tests diagnose the cause of heavy periods?
To determine the reason for heavy menstrual bleeding, your physician may recommend:
- Physical exam – Pelvic exam checks for enlargement, tenderness, or irregularities of reproductive organs.
- Blood tests – Complete blood count screens for anemia. Hormone tests check for imbalances.
- Pregnancy test – Confirms that pregnancy is not the cause.
- Ultrasound – Imaging to detect uterine fibroids, polyps, thickness of endometrial lining.
- Hysteroscopy – Visual examination of the uterine cavity using a narrow tube with camera.
- Endometrial biopsy – Removal of endometrial tissue samples to test for abnormalities.
Medical treatments for heavy periods
Treatment options will depend on the underlying cause of excessive menstrual bleeding. Some medical therapies include:
Hormonal birth control
Hormonal contraceptives that contain estrogen and progestin, like the pill, patch, ring, shot, and hormonal IUD can reduce the thickness of the endometrial lining and decrease bleeding.
NSAIDs
Non-steroidal anti-inflammatory drugs such as ibuprofen or naproxen can minimize heavy flows and relieve cramping if taken at the start of your period.
Antifibrinolytic drugs
Medications like tranexamic acid and aminocaproic acid help blood clot, which decreases menstrual bleeding.
Gonadotropin-releasing hormone (GnRH) agonists
Drugs like Lupron and Synarel shrink fibroids and polyps by suppressing estrogen production. This causes temporary menopause-like effects.
Progestin-only IUD
The hormonal IUD Mirena releases a steady dose of progestin to thin the uterine lining long-term.
Endometrial ablation
This outpatient procedure destroys (ablates) the endometrial tissue lining the uterus to reduce menstrual flow. Different techniques include electrical or thermal energy, microwave heating, hot fluid, and freezing methods.
When is surgery necessary for heavy periods?
If medication and conservative treatments fail to alleviate heavy cycles, surgical options may be appropriate, such as:
Myomectomy
Fibroids are surgically removed from the uterus through abdominal incisions.
Uterine artery embolization
The blood supply to fibroids is blocked, causing them to shrink.
Endometrial resection or ablation
The entire lining of the uterus is surgically removed or destroyed to control bleeding.
Hysterectomy
Surgical removal of the uterus offers a permanent solution for abnormal uterine bleeding.
Discuss the risks and benefits of each procedure with your gynecologist. For many women, less invasive options may be recommended before hysterectomy.
How can I manage heavy periods at home?
You can take some self-care steps to handle heavy menstrual bleeding at home:
- Use extra-absorbent sanitary pads, and change them often.
- Use a tampon and pad together for double protection.
- Reduce activity and get more rest during your period.
- Take over-the-counter pain relievers like ibuprofen to ease cramps.
- Drink plenty of fluids and eat small, frequent meals.
- Boost iron intake via foods like red meat, spinach, beans to prevent anemia.
- Use a heating pad on your abdomen and low back to relieve cramps.
However, home care is not a substitute for seeing your doctor. Make an appointment for evaluation if you experience any symptoms of menorrhagia.
Conclusion
Abnormally heavy periods are a common concern for many women. Excessive menstrual bleeding can result from hormonal imbalances, uterine abnormalities like fibroids and polyps, adenomyosis, IUDs, or other disorders. Seek medical advice if your flow routinely soaks through a pad or tampon within 2 hours, includes large clots, or lasts more than 7 days. Your doctor can run tests to determine the cause and recommend appropriate treatment to control heavy flows. Options range from medication to surgical procedures. In the meantime, use extra-absorbent feminine products, take NSAIDs for cramps, get more rest, and eat iron-rich foods. However, self-care is not an alternative to visiting your clinician. Prompt medical treatment is key to improving your symptoms and quality of life.