Women sometimes experience heavy menstrual bleeding that’s either overly heavy or lasts over a few days, a condition formerly known as menorrhagia. Generally, heavy menstrual bleeding is a widespread issue. However, most women do not lose enough blood for it to be considered heavy menstrual bleeding.
Other women may also bleed between periods or at unexpected earlier or later times in their cycle. This kind of bleeding is referred to as abnormal uterine bleeding or irregular menstrual bleeding.
Heavy menstrual bleeding can lead to significant blood flow along with cramping, making it difficult to carry out daily activities. So, if you find yourself dreading your period as a result of heavy menstrual bleeding, it’s important to consult with your doctor.
Numerous treatment approaches are available to help with this condition.
By Able Health I Medically reviewed by Dr. Alireza Estedlal
Page last reviewed: February 2024 I Next review due: February 2026
Symptoms
The possible symptoms of heavy period bleeding are:
Soaking over one or even more sanitary pads or tampons each hour for several consecutive hours.
The need to use double sanitary protection in order to manage menstrual flow.
Waking up at night to change your sanitary pads or tampons.
Bleeding that lasts over a week.
Passing blood clots that seem bigger than 1.5cm.
Restricted day-to-day activities because of heavy flow.
Feeling drained, fatigued, or short of breath due to blood loss.
Causes
At times, the cause of heavy menstrual bleeding is not known. However, several conditions can contribute to menorrhagia:
Hormonal imbalance: Normally, in a menstrual cycle, a balance between oestrogen and progesterone regulates the accumulation of the uterine lining (endometrium). This lining often sheds during menstruation. Imbalance of hormones causes the lining to become excessively thick and shed in the form of heavy menstrual bleeding or bleeding between periods. Various conditions that can lead to hormonal imbalances are obesity, thyroid problems, insulin resistance, and polycystic ovary syndrome (PCOS).
Ovaries problems: During the menstrual cycle, ovaries sometimes fail to release an egg, a condition called anovulation. If this occurs, the body does not produce progesterone hormone as it normally would during the menstrual cycle. As a result, it causes hormonal imbalance and can lead to menorrhagia or unexpected bleeding between periods.
Uterine fibroids: These are tumors that form during a woman’s childbearing years. Usually, they are benign, meaning they are noncancerous. Uterine fibroidscan lead to heavy menstrual bleeding than usual or prolonged bleeding.
Polyps: Polyps are tiny growths that develop on the uterine lining and can cause heavy or prolonged menstrual bleeding. They can also lead to bleeding between periods and bleeding or spotting after menopause. These growths are, however, noncancerous.
Adenomyosis: Glands from the uterine lining grow into the uterine wall in this condition, causing painful periods and heavy bleeding.
Intrauterine Device (IUD): Birth control hormone-free IUDs are known to cause heavy menstrual bleeding as a side effect. It’s thus important to consult your doctor for alternative birth control choices. IUDs containing progestin may alleviate heavy bleeding.
Pregnancy complications: Single, late, heavy periods might indicate a miscarriage. Unusual placenta location supplying the baby nutrients and eliminating waste is another reason for heavy bleeding during pregnancy. The placenta can be too low or cover the uterus opening (known as the cervix), a condition called placenta previa.
Cancer: Uterine or cervical cancer can lead to abnormal bleeding, unexpected or heavier than usual menstrual bleeding. These cancers can occur before or post menopause. Women with a previous abnormal Pap test have an increased likelihood of getting cervical cancer.
Inherited bleeding disorders: Certain bleeding conditions running in families can contribute to heavy menstrual bleeding. An example is von Willebrand’s disease, a disorder whereby blood doesn’t clot as it should.
Medications: Certain medicines, including hormonal birth control pills containing progestin and oestrogen, can cause heavy or prolonged menstrual bleeding. Although they are designed to reduce bleeding, they sometimes lead to unexpected bleeding between periods. Other medications preventing blood clots can also contribute to heavy bleeding.
Other health conditions: Various health conditions such as kidney, liver, and thyroid diseases can also result in heavy menstrual bleeding.
You should consult a GP if:
Heavy periods are impacting your daily life.
You have experienced heavy periods for some time.
You experience intense pain during your periods.
You bleed between periods or after sexual intercourse.
You have heavy periods accompanied by other symptoms like pain when urinating, bowel movements, or during intercourse.
Talk to our doctor if you’re concerned about symptoms
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Risk factors for heavy menstrual bleeding vary depending on a person’s age and underlying health conditions. Normally, the egg release from the ovaries prompts the production of progesterone in the body. Progesterone is a vital hormone that regulates menstrual periods. However, if an egg is not released, the body won’t create sufficient progesterone, leading to heavy period bleeding or unexpected bleeding between periods.
Heavy menstrual bleeding or irregular periods in teenagers often occur when there is no egg release during the monthly cycle. Cycles without the release of an egg are usually common in the first year after the teenager first starts menstruating.
On the other hand, heavy menstrual bleeding in older women at their reproductive age is usually because of uterine problems such as polyps, fibroids, or adenomyosis. Other issues like bleeding disorders, uterine cancer, medication side effects, and kidney or liver disease could also contribute to menorrhagia.
Complications
Prolonged or overly heavy period bleeding can result in other health conditions, such as:
Anemia: Anemia due to blood loss can occur from heavy menstrual bleeding. It is a condition whereby the body doesn’t have sufficient red blood cells to transport oxygen to the tissues. The amount of red blood cells is determined by haemoglobin, which is a protein carrying oxygen to tissues in the body.
Iron deficiency anemia arises when the body attempts to compensate for lost red blood cells. As a result, the body depletes its iron stores to produce more hemoglobin in order to ensure that adequate oxygen reaches the tissues. Mostly, heavy menstrual bleeding can cause low levels of iron, resulting in iron deficiency anemia.
The symptoms of anaemia are headaches and fatigue. While diet is mainly responsible for iron deficiency anaemia, heavy menstrual bleeding aggravates the condition.
Intense pain: Heavy menstrual bleeding may be accompanied by painful menstrual cramping, a condition referred to as dysmenorrhea. If these menstrual cramps interfere with your everyday activities, then you should consult your doctor.
Diagnosis
During heavy period bleeding diagnosis, your health care provider will likely begin by asking about your menstrual cycles and medical history. You may also be required to keep a record of details like the heaviness of your flow and the number of sanitary pads or tampons used.
After conducting a physical examination, the provider may suggest the following diagnostic tests and procedures:
Blood tests: The doctor may test a blood sample for iron deficiency anemia along with other disorders, including thyroid diseases or blood clotting issues.
Pap test: Cells from the cervix are obtained during this test and are checked for inflammation or any precancerous changes that could result in cancer. In women aged between 25 to 30 years and above, cells may as well be tested for the human papillomavirus (HPV).
Endometrial biopsy: A tissue sample from the inner part of the uterus may be removed during endometrial biopsy. It will then be examined by a pathologist for signs of cancer or precancerous uterus.
Ultrasound: This is an imaging procedure that uses sound waves to produce images of the ovaries, uterus, and pelvis.
Depending on the outcomes of these initial diagnostic tests, additional testing may be necessary, including:
Sonohysterography: This test involves injecting fluid through a tube into the uterus via the path of the vagina and cervix. Ultrasound is then used to check the uterine lining for any problems.
Hysteroscopy: During this procedure, the doctor inserts a thin, illuminated instrument into the uterus through the vagina and cervix. This enables them to clearly view the inside of the uterus.
A diagnosis of heavy menstrual bleeding or unusual uterine bleeding can only be made once other possible causes, such as health conditions, menstrual disorders, or medications, are ruled out.
Treatment
The treatment for menorrhagia depends on various factors, such as:
Medical history and overall health
The cause and severity of the condition
Your tolerance for specific drugs or procedures
The likelihood that your periods will soon be less heavy
Your plans for future pregnancies
The effect of the condition on your lifestyle
Your personal preferences or opinions
Treatment options for heavy periods
While treatment for heavy periods isn’t always required, there are options available if the condition affects your everyday life.
Treatment remedies from a GP are:
Certain forms of contraception, including an intrauterine system (IUS) or the combined contraceptive pill.
Medications like tranexamic acid which help lower bleeding.
Prescription-only anti-inflammatory painkillers, like naproxen or mefenamic acid.
A blood test to examine if a person has iron deficiency anemia is necessary. Also, in case these treatments are ineffective or if a condition is suspected to be contributing to the heavy periods, a GP will usually ask for more tests or recommend that you visit a specialist.
Procedures used to treat heavy menstrual bleeding
Hysteroscopy is generally a diagnostic and treatment option for menorrhagia. Using operative hysterectomy, the provider performs this procedure by inserting a thin, illuminated tube into the vagina to enable examination of the uterine cavity. The hysteroscope can also function as a precise surgical tool that can be used to take out any growths causing bleeding.
Apart from hysteroscopy, other treatment procedures for heavy period bleeding are:
Myomectomy: This procedure is done to take out fibroids from the uterus.
Uterine artery embolization (UAE): This procedure limits blood supply to the tumors and fibroids.
Endometrial ablation: This procedure destroys a section or all of the uterine lining. Sterilization is usually recommended afterward, as endometrial ablation can lead to serious foetal complications if pregnancy occurs.
Hysterectomy: This surgical procedure is used to remove the uterus, preventing periods and the possibility of becoming pregnant.
How is heavy period bleeding managed?
Treatment usually starts with medication and could advance to minor procedures or surgical alternatives. Discuss with your healthcare provider to determine the best treatment option based on your health and overall treatment goals.
Prevention
How to prevent heavy menstrual bleeding
Not all causes of heavy menstrual bleeding are preventable. However, consulting with your healthcare provider for diagnosis and treatment may aid in managing your bleeding and ensuring it doesn’t disrupt your quality of life.
Living With
When should you call a doctor if you suspect heavy menstrual bleeding?
Contact your healthcare provider if you experience heavy menstrual bleeding symptoms, anemia, or when your period becomes abnormal. Using an app or calendar to keep track of your periods can help you detect if your menses are heavier and last unusually longer. It’s important to share these records with your doctor.
Furthermore, consider scheduling an appointment if you discover that you need to doubleup on menstrual products or if heavy bleeding prevents you from participating in activities you like.
Can heavy menstrual bleeding be life-threatening?
While heavy periods are generally not life-threatening, they can be dangerous if you lose excess blood. Bleeding through two or even more tampons or pads every hour for two consecutive hours is an indication that you need to visit your doctor or seek emergency care right away.
What to expect from your doctor
During your appointment with your doctor, you may be asked questions such as:
