heavy periods and menstrual bleeding
Heavy periods (menorrhagia) are most commonly caused by a hormonal imbalance. However, several other factors may play a role in heavy menstrual bleeding.

Heavy periods (menorrhagia), defined as prolonged or excessive menstrual bleeding that can sometimes be painful, are most commonly caused by a hormonal imbalance. They can affect your quality of life and be a sign of an underlying medical condition that can usually be treated.

However, heavy menstrual bleeding can be caused by many different factors, such as:

Uterine fibroids and polyps:

  • These growths, which are typically noncancerous, form in or on the uterine wall and can cause excessive bleeding.

Adenomyosis:

  • In this condition, the endometrium (inner lining of the uterus) breaks through the myometrium (muscular wall of the uterus) and causes heavy bleeding.

Ovulation issues:

Cancer:

  • Heavy menstrual bleeding can be an early sign of endometrial (uterine) cancer.

Bleeding disorders:

  • Conditions such as von Willebrand disease (a genetic disorder caused by low levels of clotting protein in the blood) and other conditions can cause menorrhagia.

Endometriosis:

  • In this condition, the uterine lining grows in sites outside of the uterus (the fallopian tubes, ovaries, etc.), which can cause menorrhagia.

Pregnancy problems:

Pelvic inflammatory disease:

  • An infection of the reproductive organs with symptoms that include heavy menstrual bleeding.

Medications:

Birth control:

Age:

  • Menstrual flow tends to change with age.
  • As menopause approaches, periods tend to gradually slow and become more infrequent although there may be fluctuations.
  • Some women have heavy menstrual bleeding as they approach menopause.

How can I know if my periods are heavy or normal?

It is hard to define exactly what heavy periods are. What is heavy for one woman may be normal for another woman. Moreover, some women who think they have heavy periods may have an average amount of blood loss, whereas others who think they have normal periods may have a high amount of blood loss.

  • Most women lose 16 teaspoons of blood (80 mL) or less during periods.
  • The average amount of blood loss during periods is six to eight teaspoons.
  • According to studies, heavy periods are a symptom if blood loss is higher than 80 mL per period and/or having periods that last longer than seven days.

You will not usually need to measure your blood loss. Most women can tell when they are bleeding more than normal. Signs that your periods are heavy include:

  • Bleeding through your clothes or bedding
  • Having to change your normal lifestyle due to heavy bleeding
  • Needing to change your sanitary products every one to two hours
  • Needing to use two types of sanitary products at the same time (a tampon and a pad)
  • Passing blood clots larger than 2.5 cm

Heavy periods every month can occur with or without other symptoms. Apart from the above, symptoms of heavy periods include:

  • Feeling tired during your periods, which is caused by anemia (iron deficiency)
  • Staining of the sheets during the night and needing to replace your sanitary protection constantly
  • Period cramps
  • Periods that last more than seven days
  • Symptoms continuing for several monthly cycles

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When should I be concerned about heavy periods?

There are certain symptoms that can occur with heavy periods that require urgent evaluation by your healthcare provider, such as:

Shortness of breath:

Bleeding after menopause:

  • If menstrual bleeding starts after menopause, this could be a sign of a more serious condition such as a malignancy.

Pregnancy:

Pain:

  • Heavy menstrual periods that occur with severe pain could be a sign of a more urgent condition and may need your doctor’s intervention.

No matter the cause, there are many ways and treatments to address your heavy bleeding. Treatments include fairly simple remedies, such as iron supplements, birth control, hormone therapy and prescription medication, or surgical options, such as removal of polyps or fibroids. Together with your physician, you can find the best solution.

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Medically Reviewed on 8/11/2021
References
Heavy Menstrual Bleeding: https://www.cdc.gov/ncbddd/blooddisorders/women/menorrhagia.html

When is a heavy period too heavy: https://www.health.harvard.edu/blog/when-is-a-heavy-period-too-heavy-2020021218877

Heavy periods: Overview: https://www.ncbi.nlm.nih.gov/books/NBK279294/