- Why Is My Period So Heavy?
- A period that’s suddenly very heavy one month
- A period that is heavy on the first day
- A recurring period that is heavy and painful
- Overview – Heavy periods
- What causes heavy periods?
- Menorrhagia (Heavy Menstrual Bleeding)
- Heavy Menstrual Bleeding
- Heavy periods
Why Is My Period So Heavy?
Several conditions or issues can cause heavy periods. These heavy periods may occur frequently, or they may be more sporadic.
A period that’s suddenly very heavy one month
The signs and symptoms of an ectopic pregnancy may be confused with a heavy menstrual period. This type of pregnancy develops outside your uterus and is rarely sustainable. It can cause severe health issues, including heavy bleeding and severe cramping.
During and surrounding a miscarriage, heavy bleeding is common and may be mistaken for a very heavy period.
Nonhormonal intrauterine device (IUD)
Heavy menstrual bleeding is a common side effect of a nonhormonal IUD. After a few months with your IUD, you may find that bleeding becomes less severe.
Blood thinners can lead to blood flow problems and heavier menstrual flow.
A period that is heavy on the first day
Many women experience heavier bleeding on the first day of a period and lighter bleeding on the last days. A heavy flow that might get in the way of your normal activities is unusual.
Birth control changes
If you recently stopped using hormonal birth control, your periods may be very heavy in the first days as your cycle adjusts to the hormone changes.
Like birth control, medications you take may interfere with your cycle and lead to heavy bleeding on the first day of your period.
A recurring period that is heavy and painful
If every period is heavy, painful, and difficult to work around, you may have underlying, long-term issues.
Your body typically balances progesterone and estrogen, the two hormones that play the biggest roles in menstruation. Too much estrogen, however, can lead to thick uterine walls. This can cause heavy bleeding as the lining is eliminated during your period.
Ten to 30 percent of women with heavy periods have a bleeding disorder, such as von Willebrand disease. These disorders can make it difficult to stop your bleeding.
These small growths on the lining of the uterus can make periods heavier.
These noncancerous growths are usually larger than polyps. They typically develop inside your uterus and can cause heavier periods.
Cancer in your uterus, cervix, and ovaries are rarely the sole cause of heavy bleeding but a heavier period may be a symptom.
During this transition before menopause, you may experience hormonal changes and unusually heavy bleeding during your period.
After you have a baby, heavy periods aren’t uncommon. These changes may be permanent or your period may return to a flow similar to what you had before getting pregnant.
What causes heavy periods?
In about half of women with heavy menstrual bleeding, no underlying reason is found.
But there are several conditions and some treatments that can cause heavy menstrual bleeding.
Some conditions of the womb and ovaries can cause heavy bleeding, including:
- fibroids – non-cancerous growths that develop in or around the womb and can cause heavy or painful periods
- endometriosis – where the tissue that lines the womb (endometrium) is found outside the womb, such as in the ovaries and fallopian tubes (although this is more likely to cause painful periods)
- adenomyosis – when tissue from the womb lining becomes embedded in the wall of the womb; this can also cause painful periods
- pelvic inflammatory disease (PID) – an infection in the upper genital tract (the womb, fallopian tubes or ovaries) that can cause symptoms like pelvic or abdominal pain, bleeding after sex or between periods, vaginal discharge and a high temperature
- endometrial polyps – non-cancerous growths in the lining of the womb or cervix (neck of the womb)
- cancer of the womb – the most common symptom is abnormal bleeding, especially after the menopause
- polycystic ovary syndrome (PCOS) – a common condition that affects how the ovaries work; it causes irregular periods, and periods can be heavy when they start again
Other conditions that can cause heavy periods include:
- blood clotting disorders, such as Von Willebrand disease
- an underactive thyroid gland (hypothyroidism) – where the thyroid gland does not produce enough hormones, causing tiredness, weight gain and feelings of depression
Medical treatments that can sometimes cause heavy periods include:
- an IUD (intrauterine contraceptive device, or “the coil”) – this can make your periods heavier for the first 3 to 6 months after insertion
- anticoagulant medicine – taken to prevent blood clots
- some medicines used for chemotherapy
- some herbal supplements, which can affect your hormones and may affect your periods – such as ginseng, ginkgo and soya
Menorrhagia (Heavy Menstrual Bleeding)
What is menorrhagia?
Menorrhagia is a common disorder in women. Menorrhagia is the medical term for menstrual bleeding lasting for longer than 7 days. About 1 in every 20 women has menorrhagia.
Some of the bleeding can be very heavy, meaning you would change your tampon or pad after less than 2 hours. It can also mean you pass clots the size of a quarter or even larger.
Menorrhagia can lead to anemia if not treated. Also, the heavy bleeding can affect sleep, cause lower abdominal pain and make enjoyable activities a burden.
If you are experiencing weakness and a disruption to everyday life due to heavy bleeding, you should ask your doctor for treatment options.
What are the signs and symptoms of menorrhagia?
Signs of menorrhagia include:
- Soaking 1 or more tampons or pads every hour for many consecutive hours
- Doubling up on pads
- Changing pads or tampons during the night
- Long-lasting menstrual periods (longer than 7 days)
- Blood clots the size of a quarter or larger
- Bleeding that is keeping you from doing normal activities
- Constant pain in lower part of stomach
- Lacking energy
- Shortness of breath
What causes menorrhagia?
Menorrhagia can be caused by uterine problems, hormone problems or other illnesses. Other causes include:
- Growths or tumors of the uterus that are not cancer
- Cancer of the cervix or uterus
- Particular types of birth control
- Pregnancy-related problems (miscarriage or ectopic pregnancy, when the fertilized egg implants outside the uterus)
- Bleeding disorders
- Liver, kidney or thyroid disease
- Pelvic inflammatory disease (and infection of the female reproductive organs)
- Taking certain drugs, such as aspirin
- The menopause transition, also referred to as perimenopause
- Fibroids or polyps in the lining or muscle of the womb
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Heavy Menstrual Bleeding
Menorrhagia is menstrual bleeding that lasts more than 7 days. It can also be bleeding that is very heavy. How do you know if you have heavy bleeding? If you need to change your tampon or pad after less than 2 hours or you pass clots the size of a quarter or larger, that is heavy bleeding. If you have this type of bleeding, you should see a doctor.
Untreated heavy or prolonged bleeding can stop you from living your life to the fullest. It also can cause anemia. Anemia is a common blood problem that can leave you feeling tired or weak. If you have a bleeding problem, it could lead to other health problems. Sometimes treatments, such as dilation and curettage (D&C)External or a hysterectomyExternal, might be done when these procedures could have been avoided.
Possible causes fall into the following three areas:
- Uterine-related problems
- Growths or tumors of the uterus that are not cancer; these can be called uterine fibroids or polyps.
- Cancer of the uterus or cervix.
- Certain types of birth control—for example, an intrauterine device (IUD).
- Problems related to pregnancy, such as a miscarriage or ectopic pregnancy, can cause abnormal bleeding. A miscarriage is when an unborn baby (also called a fetus) dies in the uterus. An ectopic pregnancy is when a baby starts to grow outside the womb (uterus), which is not safe.
- Hormone-related problems
- Other illnesses or disorders
- Bleeding-related disorders, such as von Willebrand disease (VWD) or platelet function disorder.
- Nonbleeding-related disorders such as liver, kidney, or thyroid disease; pelvic inflammatory disease; and cancer.
In addition, certain drugs, such as aspirin, can cause increased bleeding. Doctors have not been able to find the cause in half of all women who have this problem. If you have bleeding such as this, and your gynecologist has not found any problems during your routine visit, you should be tested for a bleeding disorder.
You might have menorrhagia if you:
- Have a menstrual flow that soaks through one or more pads or tampons every hour for several hours in a row.
- Need to double up on pads to control your menstrual flow.
- Need to change pads or tampons during the night.
- Have menstrual periods lasting more than 7 days.
- Have a menstrual flow with blood clots the size of a quarter or larger.
- Have a heavy menstrual flow that keeps you from doing the things you would do normally.
- Have constant pain in the lower part of the stomach during your periods.
- Are tired, lack energy, or are short of breath.
Finding out if a woman has heavy menstrual bleeding often is not easy because each person might think of “heavy bleeding” in a different way. Usually, menstrual bleeding lasts about 4 to 5 days and the amount of blood lost is small (2 to 3 tablespoons). However, women who have menorrhagia usually bleed for more than 7 days and lose twice as much blood. If you have bleeding that lasts longer than 7 days per period, or is so heavy that you have to change your pad or tampon nearly every hour, you need to talk with your doctor.
To find out if you have menorrhagia, your doctor will ask you about your medical history and menstrual cycles.
He or she may ask you questions like the following:
- How old were you when you got your first period?
- How long is your menstrual cycle?
- How many days does your period usually last?
- How many days do you consider your period to be heavy?
- How do your periods affect your quality of life?
Your doctor may also ask if any of your family members have had heavy menstrual bleeding. He or she may also have you complete this questionnaire Cdc-pdf to help determine if you need to be tested for a possible bleeding disorder.
You might want to track your periods by writing down the dates of your periods and how heavy you think your flow is (maybe by counting how many pads or tampons you use). Do this before you visit the doctor so that you can give the doctor as much information as possible. Above is a picture of a chart that is used by some doctors to track your period. You can make your own chart based on the one shown. Your doctor also will do a pelvic exam and might tell you about other tests that can be done to help find out if you have menorrhagia.
Your doctor might tell you that one or more of the following tests will help find out if you have a bleeding problem:
- Blood test. In this test, your blood will be taken using a needle. It will then be looked at to check for anemia, problems with the thyroid, or problems with the way the blood clots.
- Pap test. For this test, cells from your cervix are removed and then looked at to find out if you have an infection, inflammation, or changes in your cells that might be cancer or might cause cancer.
- Endometrial biopsy. Tissue samples are taken from the inside lining of your uterus or “endometrium” to find out if you have cancer or other abnormal cells. You might feel as if you were having a bad menstrual cramp while this test is being done. But, it does not take long, and the pain usually goes away when the test ends.
- Ultrasound. This is a painless test using sound waves and a computer to show what your blood vessels, tissues, and organs look like. Your doctor then can see how they are working and check your blood flow.
Using the results of these first tests, the doctor might recommend more tests, including,
- Sonohysterogram. This ultrasound scan is done after fluid is injected through a tube into the uterus by way of your vagina and cervix. This lets your doctor look for problems in the lining of your uterus. Mild to moderate cramping or pressure can be felt during this procedure.
- Hysteroscopy. This is a procedure to look at the inside of the uterus using a tiny tool to see if you have fibroids, polyps, or other problems that might be causing bleeding. You might be given drugs to put you to sleep (this is known as “general anesthesia) or drugs simply to numb the area being looked at (this is called “local anesthesia”).
- Dilation and Curettage (D&C). This is a procedure (or test) that can be used to find and treat the cause of bleeding. During a D&C, the inside lining of your uterus is scraped and looked at to see what might be causing the bleeding. A D&C is a simple procedure. Most often it is done in an operating room, but you will not have to stay in the hospital afterwards. You might be given drugs to make you sleep during the procedure, or you might be given something that will numb only the area to be worked on.
The type of treatment you get will depend on the cause of your bleeding and how serious it is. Your doctor also will look at things such as your age, general health, and medical history; how well you respond to certain medicines, procedures, or therapies; and your wants and needs. For example, some women do not want to have a period, some want to know when they can usually expect to have their period, and some want just to reduce the amount of bleeding. Some women want to make sure they can still have children in the future. Others want to lessen the pain more than they want to reduce the amount of bleeding. Some treatments are ongoing and others are done one time. You should discuss all of your options with your doctor to decide which is best for you. Following is a list of the more common treatments.
- Iron supplements. To get more iron into your blood to help it carry oxygen if you show signs of anemia.
- Ibuprofen (Advil). To help reduce pain, menstrual cramps, and the amount of bleeding. In some women, NSAIDS can increase the risk of bleeding.
- Birth control pills. To help make periods more regular and reduce the amount of bleeding.
- Intrauterine contraception (IUC). To help make periods more regular and reduce the amount of bleeding through drug-releasing devices placed into the uterus.
- Hormone therapy (drugs that contain estrogen and/or progesterone). To reduce the amount of bleeding.
- Desmopressin Nasal Spray (Stimate®). To stop bleeding in people who have certain bleeding disorders, such as von Willebrand disease and mild hemophilia, by releasing a clotting protein or “factor”, stored in the lining of the blood vessels that helps the blood to clot and temporarily increasing the level of these proteins in the blood.
- Antifibrinolytic medicines (tranexamic acid, aminocaproic acid). To reduce the amount of bleeding by stopping a clot from breaking down once it has formed.
- Dilation and Curettage (D&C). A procedure in which the top layer of the uterus lining is removed to reduce menstrual bleeding. This procedure might need to be repeated over time.
- Operative hysteroscopy. A surgical procedure, using a special tool to view the inside of the uterus, that can be used to help remove polyps and fibroids, correct abnormalities of the uterus, and remove the lining of the uterus to manage heavy menstrual flow.
- Endometrial ablation or resection. Two types of surgical procedures using different techniques in which all or part of the lining of the uterus is removed to control menstrual bleeding. While some patients will stop having menstrual periods altogether, others may continue to have periods but the menstrual flow will be lighter than before. Although the procedures do not remove the uterus, they will prevent women from having children in the future.
- Hysterectomy. A major operation requiring hospitalization that involves surgically removing the entire uterus. After having this procedure, a woman can no longer become pregnant and will stop having her period.
Menorrhagia is common among women. But, many women do not know that they can get help for it. Others do not get help because they are too embarrassed to talk with a doctor about their problem. Talking openly with your doctor is very important in making sure you are diagnosed properly and get the right treatment.
Who is Affected
Heavy bleeding (menorrhagia) is one of the most common problems women report to their doctors. It affects more than 10 million American women each year. This means that about one out of every five women has it.
Heavy or excessive menstrual bleeding can be a distressing problem, and is one of the most common reasons for women to visit their GP. 1 in 3 women describe their period as heavy and 1 in 20 women consult their GP every year about this problem.
In more than half of cases heavy menstrual bleeding has no obvious cause. However, it is sometimes related to the presence of organic disease. Known common causes include:
- Fibroids: benign enlargements of muscle in the wall of the womb
- Endometrial polyps: benign outgrowths of the lining of the womb
- Endometriosis: misplaced lining of the womb
- Pelvic inflammatory disease: infection of the pelvis
- Polycystic Ovarian Syndrome (PCOS)
- Cancer of the womb lining (Endometrial Carcinoma)
For more information on these conditions, see the relevant WHC factsheets. Other causes of irregular and heavy bleeding may be:
- Abnormal hormone cycles
- Blood clotting disorders (rare)
- Thyroid gland problems – (also rare)
- Intra-uterine contraceptive devices (IUCDs)
- Warfarin or a similar blood thinning medicine
- Some medicines used in chemotherapy
Oral contraceptive pills make most women’s periods lighter. Hence, if you stop taking contraceptive, it may appear that your menstrual periods have become heavier, when they are really returning to what is normal for you.
Symptoms and effects
The average total amount of blood lost during a period is 35ml – about half a tea cup.
Bleeding is considered abnormal when more than 80ml is lost, because if you are losing more than 80 ml during periods, you are at a risk of developing anaemia. Some women lose much more blood. Bleeding more than a litre each month has been recorded, but this is very unusual. Regular heavy periods with no other bleeding during the cycle are not normally associated with significant disease in young women. Irregular heavy periods and bleeding between periods or after sexual intercourse may indicate a serious condition. Other symptoms to watch out for include prolonged periods, tiredness, light headedness, poor sleep patterns and breathlessness. Although in most cases irregular periods do not indicate a serious condition, it is always wise to seek advice from your GP.
It is often not easy to know whether your periods are heavier than other women or not. Measuring blood loss during menstrual period is not easy either. Hence blood loss during menstrual period is considered heavy if it causes one or more of the following:
- Flooding through clothes
- You pass large clots
- You need frequent change of sanitary towels or tampons
- You need double sanitary protection
- Heavy periods occurring every month which stops you doing routine activities such as going out, working or shopping
In cases of abnormal bleeding it is important to discover if there is any underlying problem in the pelvis. This is done by means of a simple pelvic examination. The doctor inspects the vulva, vagina and cervix (neck of the uterus) to make sure there is no abnormality that could account for the bleeding. At the same time the doctor can check for signs of other conditions such as fibroids or endometriosis. A blood test is often performed to check for anaemia.
Sometimes further tests are needed.
These may include:
- Transvaginal ultrasound scan: This is useful if any swelling is found on examination of the pelvis
- Endometrial biopsy: A sample of the lining of uterus is taken and examined under a microscope
- Hysteroscopy: A thin telescope is passed through the cervix so that the uterine cavity can be examined
- Internal swabs: to check for infections
Keeping a menstrual diary may help you and your doctor to understand the pattern of your menstrual period and decide what test or treatment may be helpful. Keeping a menstrual diary is also likely to help in monitoring the effects of treatment.
Treatment options depend on the type and duration of abnormal bleeding, the presence of specific disease or condition, your age, and desire for further pregnancies. Treatment can be medical or surgical.
Once a serious condition has been excluded, you may choose not to have any treatment especially if symptoms are not significantly affecting your health or quality of life.
Medical treatments include taking medicines which act either by reducing levels of prostaglandins, or by affecting the blood clotting process that takes place in the uterus during periods. A commonly prescribed drug is tranexamic acid. This is taken in tablet form, and helps to reduce blood loss but does not reduce the duration of bleeding. Hormones such as progestogens or the combined oral contraceptive pill can also be prescribed, for regularising irregular periods and reducing the amount of blood loss. An intra-uterine progestogen releasing system, has been shown to be very effective in reducing the amount of blood loss, and indeed, periods may almost disappear after six months. The device is effective for five years. Hormone replacement therapy may benefit women nearing the menopause who also have menopausal symptoms, but should not be used purely to control bleeding. In cases of severe bleeding, it may be necessary to administer a drug which stops your ovaries working (causing a temporary menopause) and your periods may stop altogether.
It was believed for many years that a curettage – scraping out the uterine lining – reduced bleeding, but now it is known that this procedure does not have any long term beneficial effect. The definite and most effective treatment for abnormal bleeding is removal of the uterus, or ‘hysterectomy’. Endometrial ablation is a technique which involves local destruction or removal of the uterine lining. However, it is not suitable for all women. For more information on these procedures see our related factsheets: Hysterectomy and Endometrial ablation.
Menstruation varies from person to person, making it harder to distinguish normal from excessive blood loss. So how do you tell what is “normal?”
Let’s get medical: In clinical research studies, the symptom of heavy menstrual bleeding (HMB) is defined as blood loss larger than 80 mL per cycle.
However, blood loss can be very hard to measure, unless you use a menstrual cup. And even if you lose less than 80 mL, it can still affect your quality of life, particularly if the timing of your periods is irregular and, therefore, difficult to anticipate. Consequently, the more accepted and practical definition of HMB is “excessive menstrual blood loss which interferes with a woman’s physical, social, emotional and/or material quality of life.”(National Institute for Health and Care Excellence or NICE)
Causes of Heavy Menstrual Bleeding
There are a variety of conditions that can cause HMB. The most common conditions include:
- Polyps, or growths in the uterine lining, usually cause spotting or bleeding between periods and sometimes HMB.
- Adenomyosis, the abnormal growth of uterine lining (endometrium) into the muscular wall of uterus, but can sometimes cause heavy and/or painful periods.
- Uterine fibroids, benign growths (smooth muscle tumors) on the uterus, also known as leiomyomas, can sometimes cause HMB. If they grow in the uterine lining (endometrium) they will most likely cause HMB.
- Cancers and precancers are very uncommon, but important, causes of abnormal bleeding, particularly for individuals under the age of 40. While they can cause HMB, cancers and precancers more likely cause irregular bleeding or bleeding between periods.
- Coagulopathy, an inherited disorder preventing the blood from clotting normally, will cause HMB usually from menarche (the first period).
- Ovulatory disorder, the absence or irregularity of ovulation, is a hormonal problem that may cause irregular bleeding that may or may not include HMB as a symptom.
- Endometrial disorder, an abnormality in the lining of the uterus, prevents the tissues from stopping the bleeding normally.
Most medications and birth control pills don’t cause HMB, but there are two exceptions: Copper-containing intrauterine devices may increase the amount of blood lost during menstruation and anticoagulants (“blood thinners”), which prevent blood clots, usually cause HMB.
Do you have Heavy Menstrual Bleeding?
Understanding whether or not you suffer from HMB requires the accurate recording of your menstrual history. The intensity of bleeding varies from person to person, so determining what is clinically heavy is tricky. Furthermore, while a single period can be heavy, a real problem isn’t likely to exist unless the HMB is present at least most of the time. The medical definition of this is when HMB is present for the majority of periods within the previous six months. Entering your bleeding intensity diligently and correctly in the Clue app will make it easier to assess if bleeding qualifies as heavy.
Your healthcare provider may ask you how many (and what size) pads/tampons you have been using in one day. Also, blood clots are very important to note — their size, number and color. They contain blood, and it is important to measure and count them to get an approximation of how much blood has been lost.
- Distinguish between regular and maxi tampons or pads, as maxi can usually absorb twice more than regular (each maxi tampon or pad should be counted as two regulars).
- Check how soaked your tampon or pad is. Is it fully soaked with blood, or just half? (For half soaked, divide the number of half soaked pads by two.)
- Count blood clots; they contain blood too.
- For a menstrual cup, check the volume capacity and measure how full the cup is (e.g. if it is a 10 mL cup and it is ¾ full, the amount of the blood your menstrual cup contains is 7.5mL).
- If the number of soaked tampons or pads is sixteen or more for the entire duration of your period (or eight fully soaked maxi tampons or pads), then your flow is heavy.
- If you note 80mL or more blood with your menstrual cup for one entire cycle, your flow is heavy.
Here are some more guidelines to determine if what you are experiencing is heavy:
- Your menstrual period lasts longer than seven days.
- Your flow soaks through tampons or pads every hour for a few hours in a row.
- You need to change pads or tampons during the night.
- You have multiple grape-sized (or larger) blood clots.
- Your heavy menstrual flow keeps you from doing things you would normally do.
- You are tired, have a lack of energy or are short of breath.
- You feel heavy pain in your abdomen and lower back.
Make an appointment with your gynecologist if your menstrual bleeding seems heavier than usual, or if it lasts more than seven days or impacts your life.
If you experience bleeding between periods, during or after sex, during pregnancy or after you have entered menopause, it is important to visit your gynecologist.
Possible consequences of Heavy Menstrual Bleeding
Whenever you have a period, you lose blood. For those with normal bleeding, and a diet containing normal amounts of iron, blood loss and iron intake should be in balance. However, for those with heavy menstrual bleeding, and especially when the diet is deficient in iron, blood loss can exceed iron intake and may result in an iron deficiency and possible low red blood count, or anemia. Iron deficiency, with or without anemia, can cause fatigue and interfere with the ability to concentrate, exercise, and, enjoy life in general.
What should I do about it?
To treat HMB, you and your healthcare provider need to determine its cause or causes. This can be done by a few simple tests including a blood test, a transvaginal ultrasound and/or taking a sample tissue from the uterine lining (endometrial biopsy).
Polyps: Surgical removal of the polyp is the most effective therapy.
Adenomyosis: Treatment with hormonal contraception, especially an intrauterine device that releases a hormone called progestin.
Fibroids: Some medical or hormonal therapies are effective, although procedures involving surgery are often necessary.
Cancer or pre-cancer: Most pre-cancers can be treated with medication, but cancers usually require surgery.
Blood clotting disorder: Tranexamic acid or hormonal medications are the usual treatment strategy.
Ovulatory disorders: Ovulatory disorders can generally be treated with hormonal medication such as progestins or other hormonal contraceptive medications.
Endometrial disorders: People with endometrial disorders can respond well to tranexamic acid, use of simple NSAIDs like ibuprofen, naproxen or mefenamic acid, the progestin-releasing intrauterine system or other types of hormonal contraception. When a copper intrauterine device is the cause, some of the treatments for endometrial disorders can be effective.
Iron deficiency: Whenever there is an iron deficiency, and especially if there is anemia, an iron replacement should be part of the treatment.
Surgery can be important especially for removal of polyps or fibroids since it can be performed simply and in a way that preserves fertility. Finally, invasive surgery (such as endometrial ablation and hysterectomy) is the last resort to help with the HMB, but is always carefully considered as these procedures can remove your chances to bear children.
If you suspect you might have HMB, contact your healthcare provider immediately. This condition is easily treated in most of the cases. Early detection and diagnosis will make treatment more successful and less invasive.
If you are still unsure if you have HMB, try to track more details during your next cycle, and analyze it afterwards. If you note any of the signs we have mentioned here, book an appointment with your healthcare provider.