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.
- In this condition, the endometrium (inner lining of the uterus) breaks through the myometrium (muscular wall of the uterus) and causes heavy bleeding.
- If you don’t ovulate or bleed regularly, parts of the endometrium (innermost uterine lining) may become too thick.
- This can occur in women with polycystic ovary syndrome (a hormonal disorder that causes enlarged ovaries with small cysts) and hypothyroidism (when the thyroid gland doesn’t produce enough thyroid hormone).
- Heavy menstrual bleeding can be an early sign of endometrial (uterine) cancer.
- 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.
- In this condition, the uterine lining grows in sites outside of the uterus (the fallopian tubes, ovaries, etc.), which can cause menorrhagia.
- Ectopic pregnancy (when the fertilized egg gets implanted outside the uterus) and miscarriage can cause heavy menstrual bleeding.
- An infection of the reproductive organs with symptoms that include heavy menstrual bleeding.
- Anticoagulants such as aspirin can cause increased bleeding in women.
- Herbal supplements such as ginseng, ginkgo and soy may cause heavy bleeding as a side effect.
- Some types of chemotherapy may also cause heavy bleeding.
- Most oral contraceptive pills tend to normalize your menstrual flow.
- However, certain birth control methods, such as a copper intrauterine device (IUD), can result in increased menstrual bleeding.
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:
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 can be a symptom of anemia, a condition in which the body has a low hemoglobin level due to excessive blood loss and cannot keep up with its replacement of red blood cells.
- This can also cause severe tiredness, light-headedness or dizziness.
- If anemia is severe, a woman may require a blood transfusion.
Bleeding after menopause:
- If menstrual bleeding starts after menopause, this could be a sign of a more serious condition such as a malignancy.
- If you have heavy vaginal bleeding and you have had a positive pregnancy test, make sure to contact your doctor immediately.
- 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.
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/
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