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Lots of blood period: Menorrhagia (heavy menstrual bleeding) – Symptoms and causes

How to stop heavy periods – causes and treatments

A couple heavy flow days at the beginning of your period is normal. We’ve all leaked through a tampon or noticed a couple blood clots on our pads at the end of the day.

But if you change your sheets in the morning because you bleed through your tampon or pad at night, avoid wearing light-colored clothing during your cycle or cram your purse full of tampons, you could have chronic heavy periods. Keep reading to learn what may be causing your heavy period, how to tell the difference between normal and excessive menstrual bleeding, what treatments are available and more.

But what may be causing your heavy periods? How can you tell the difference between normal and heavy menstrual bleeding? And what treatments are available for heavy periods?

Below, we answer all those questions and more.

Why do I have heavy bleeding during my periods?

There are many different causes of menorrhagia, which is the medical term for heavy periods. The good news is that most of these causes are treatable. Because each woman’s period is unique, seeing the doctor is the only way to know for sure what’s causing your heavy periods. The most common causes of heavy periods include:

  • Life changes – Our bodies are sensitive to change. Even stress can cause abnormal periods. So it shouldn’t come as a surprise that big life changes may affect your cycle. It’s common to experience heavy period flow after pregnancy or childbirth, or during the time your body transitions to menopause (perimenopause).
  • Changes to your medications or birth control – Heavy periods are a side effect of some medications, especially blood thinners. And some forms of birth control can affect the length of your menstrual cycle and how much you bleed. For example, using a copper or hormonal intrauterine device (IUD) can cause heavier periods for 3-6 months. Talk to your doctor if you notice changes to your period after starting a medication or birth control.
  • Hormone imbalance – Too much or too little estrogen and progesterone can cause menorrhagia. Some women experience high levels of estrogen and low levels of progesterone. This can cause the uterine lining to thicken. When a thick uterine lining sheds during menstruation, women might experience heavier blood flows and larger blood clots.
  • Uterine fibroids – Fibroids are noncancerous growths inside the uterus. They range in size from a grain of sand to a large mass that can affect the size of your uterus. If your doctor finds fibroids in your uterus, they might recommend removing them to treat your heavy periods.
  • Endometriosis – Endometriosis is a painful condition that causes abnormal growth of the uterine lining and forms uterine polyps. It can cause short period cycles and heavy, painful periods as your body sheds the thickened uterine lining. About one in 10 women in the United States has endometriosis.

What is considered menorrhagia?

You might be surprised to learn that about one in five women experience menorrhagia. Since everyone is different, it can be tricky to know if what you think is “normal” for your cycle would be considered a heavy period. In fact, half of women who experience menorrhagia don’t actually know they have it.

Recognizing menorrhagia symptoms

The best way to figure out if you’re experiencing chronically heavy period bleeding is to talk to a doctor. But there are some general signs that point toward menorrhagia. According to the American College of Obstetricians and Gynecologists, any of the following is considered a symptom of heavy menstrual bleeding:

  • Bleeding for more than seven days
  • Bleeding through one or more tampons or pads every hour
  • You need to change your pad or tampon during the night
  • You need to double up on protection to keep from leaking
  • You notice blood clots the size of a quarter or larger

If left untreated, heavy period bleeding can also lead to anemia, which is when you don’t have enough red blood cells to circulate the amount of oxygen your body needs. This can cause other physical symptoms, such as:

  • Fatigue
  • Lightheadedness
  • Shortness of breath

How is menorrhagia diagnosed?

Diagnosing menorrhagia has two parts: confirming that your bleeding is unusually heavy and identifying the underlying cause.

For the first part, your doctor will ask you questions about your medical and menstrual histories. For the second part, one or more tests may be used. Examples include:

  • A blood test to check hormone levels and look for signs of anemia or clotting issues.
  • A Pap test, where cells from your cervix are examined for signs of infection, inflammation or other unusual changes.
  • An endometrial biopsy, which involves taking samples from your uterine lining. The samples are looked at to see if any unusual or cancerous cells are present.
  • An ultrasound, which uses sound waves to check for dysfunction in the pelvic organs, as well as blood flow issues.
  • A sonohysterogram, another kind of ultrasound that’s done while your uterus is filled with liquid to get a better look at the uterine lining.
  • A hysteroscopy, where a very small, flexible camera is used to examine the uterus for fibroids, polyps and other possible causes of bleeding issues.

How can I stop heavy periods (menorrhagia)?

Knowing the underlying reason for your heavy periods is key to getting the treatment that will be most effective for you, which is why talking to a doctor is so important. In some cases, heavy menstrual bleeding caused by fibroids, growths or endometriosis are best treated through surgery. But most often, menorrhagia treatment is a matter of lifestyle changes and medication, such as:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – Select NSAIDs like ibuprofen can reduce pain caused by menorrhagia and make your periods lighter. This is because NSAIDs reduce the amount of prostaglandins – hormones that cause pain and bleeding – in your uterine lining. While ibuprofen is helpful, some NSAIDs like aspirin that have blood-thinning effects should not be used for this purpose, as they may make bleeding worse.
  • Birth control – Pills, patches, hormonal IUDs and other forms of hormonal birth control can regulate your periods as well. Hormonal birth control can thin the uterine lining, which reduces the amount of blood and tissue you lose during your menstrual cycle. Birth control can also be used to regulate the length of your cycle, alleviate painful cramps or even as a way to stop your period altogether. If you’re entering perimenopause or menopause, birth control can help manage menopause symptoms.
  • Hormone therapy – When heavy periods are caused by a hormonal imbalance, hormone therapy may reduce bleeding. Like hormonal birth control, hormone therapy can be used regularly to thin the uterine lining and help keep your hormones balanced. Hormone therapy can also be used to treat conditions like endometriosis that cause pain and menstrual bleeding.
  • Other medicines– In some cases, other medicines that require a doctor’s prescription can be used to help treat menorrhagia symptoms. Examples include stronger NSAIDs, tranexamic acid and desmopressin. Tranexamic acid can be taken at the start of a menstrual period to reduce bleeding, and desmopressin reduces bleeding by helping blood clot.
  • Diet changes – Although it won’t stop menorrhagia, eating a diet rich in iron can help prevent anemia. Iron-rich foods include meat, seafood, beans, nuts, seeds and leafy green vegetables. Eating foods with lots of vitamin C like oranges, bell peppers and broccoli can help your body absorb extra iron in your diet. Also, do your best to avoid foods with processed sugar, trans-fats and starchy carbs. These foods can make menorrhagia symptoms worse. Also, if you’re unable to get enough iron through food, your doctor may recommend an iron vitamin supplement.

Heavy periods aren’t something that you have to put up with. If your period affects your daily life by causing you to miss work or school, cancel social activities or plan your day around bathroom breaks, make an appointment with a women’s health expert or a primary care doctor. At HealthPartners, you can choose from in-person or video visit options.

Women’s health experts like OB-GYNs specialize in female reproductive health, including heavy periods. And primary care doctors can diagnose and treat hundreds of conditions, as well as connect you with a specialist if more advanced care is needed.

Signs you are losing too much blood during your period

Most people lose around 2–3 tablespoons of blood during their period. People with heavy periods may lose twice as much. Fatigue or weakness may be signs that a person is losing too much blood.

This figure comes from the Centers for Disease Control and Prevention (CDC).

Menorrhagia is the medical term for heavy menstrual bleeding. A person has heavy periods if they need to change their pad or tampon less than every 2 hours, or if they pass clots the size of a quarter or bigger.

Heavy periods can be a sign of an underlying health issue. Sometimes, a person may mistake an early miscarriage for a heavy period. Sudden, very heavy bleeding may be a medical emergency.

Read on to learn about signs you are losing too much blood during a period.

A typical period causes around 2–3 tablespoons (tbsps) of blood loss. However, this may vary from person to person. A person with heavy periods may have twice as much blood loss, while others may have less.

It can be difficult to measure the precise volume of blood loss at home. Using a menstrual cup can help to measure the blood loss, which may help a person give their doctor more precise information.

Another way to quantify blood loss is to examine how often a person changes their pad or tampon. A person is losing too much blood during their period if they:

  • soak through a pad or tampon once an hour for several hours
  • pass large clots the size of a quarter or bigger
  • have to use two pads at a time to prevent leaks
  • have to change pads or tampons during sleeping hours

People can have heavy periods without experiencing any additional symptoms. However, sometimes the blood loss can contribute to anemia. This may cause:

  • shortness of breath
  • low energy
  • weakness

A person does not have to have these symptoms to get help from a doctor. Heavy bleeding alone may indicate that there is an underlying condition.

Heavy periods are not usually an emergency. However, people can mistake other conditions for a heavy period. These other conditions can require urgent treatment.

For example, postpartum hemorrhage can occur up to 12 weeks after giving birth. Injuries to the uterus and bleeding disorders can also cause dangerous bleeding that requires emergency treatment.

Additionally, an ectopic pregnancy or miscarriage can mimic a heavy period, and may be mistaken for one if a person does not know they were pregnant. An ectopic pregnancy occurs when the pregnancy begins outside the uterus, usually in the fallopian tube.

If a person starts losing a lot of blood from the vagina, or has the following symptoms, call 911:

  • pale or clammy skin
  • rapid heart rate
  • nausea
  • dizziness
  • blurry vision
  • fainting
  • swelling around the vagina, or in the space between the vagina and anus (perineum)

If a person often has periods that soak through tampons and pads within a few hours or less, or that consist of large clots, they should also speak with a doctor.

Some potential causes of heavy periods include:

  • irregular ovulation, which is common in puberty, perimenopause, and in people with conditions such as polycystic ovary syndrome
  • intrauterine devices (IUDs)
  • hormonal imbalances
  • obesity, as this can elevate the amount of estrogen in the body
  • endometriosis
  • adenomyosis
  • uterine growths, such as fibroids or polyps
  • infections such as pelvic inflammatory disease (PID)
  • kidney, liver, or thyroid disease
  • cancer of the uterus, cervix, or reproductive tract
  • certain medications, such as blood thinners
  • bleeding disorders, such as von Willebrand disease

As many as 20% of people with unusually heavy periods have a bleeding disorder, or coagulopathy.

Frequent nose bleeds, bleeding gums, bruising, or significant bleeding from minor cuts may indicate a person has coagulopathy.

Doctors may be able to diagnose heavy periods by asking about a person’s symptoms. If they regularly experience heavier blood loss than is typical, or that the blood loss causes symptoms of anemia, they may give a diagnosis of menorrhagia.

The doctor should also perform tests to check for the potential causes, or complications of, having heavy periods. This may include a:

  • complete blood count
  • iron status test
  • thyroid hormone test
  • liver function test
  • pregnancy test
  • sexually transmitted infection tests
  • coagulopathy tests

A doctor may also recommend scanning the uterus and ovaries to assess the cause. This may show signs of growths or lesions.

If they the suspect the growths result from polyps or cancer, they may perform a biopsy to test the uterine tissue.

Treatment for heavy vaginal bleeding will depend on the severity of the blood loss, and on what is causing it.

Severe bleeding

If the bleeding is severe, the first goal for doctors may be to reduce the bleeding. To do this, they may fit an IV line, give a blood transfusion, or apply pressure inside the uterus using a Bakri balloon or gauze.

Another way doctors can reduce bleeding is to ensure the bladder is empty and is not in the way of the uterus contracting. They can empty the bladder with a Foley catheter.

Doctors will then examine the cause of the bleed to determine further treatment. For example, they can remove remaining products in the uterus during surgery. They may administer IV drugs to stop bleeding.

In some cases, a doctor may administer short-term hormone therapy to stop the bleeding. They may also give hormonal contraceptives to take home, as this may prevent bleeding from recurring.

If these measures do not work, surgery may be necessary. Dilation and curettage removes the top layer of the uterine lining, which can quickly stop bleeding.

Pregnancy-related conditions

If the bleeding is the result of a pregnancy-related complication, treatment may involve:

  • Monitoring: If doctors identify an ectopic pregnancy early, they may monitor it to see if treatment is necessary. Ectopic pregnancies are not viable, and sometimes, the pregnancy will end on its own.
  • Medication: Postpartum hemorrhage usually requires medication, such as pitocin or methergine, to stop the bleeding. If the bleeding is severe, a person may need a blood transfusion, or IV estrogen. A hysterectomy may also be necessary in life threatening circumstances.
  • Surgery: A miscarriage or more advanced ectopic pregnancy may require surgery to remove the pregnancy.

Other conditions

If the bleeding is unrelated to pregnancy, treatment focuses on identifying and managing the underlying cause, and reducing the symptoms. This may involve:

  • IUD removal
  • hormonal contraceptives
  • hormone replacement therapy, for heavy bleeding due to perimenopause
  • medications to treat thyroid or liver disorders
  • medications for bleedings disorders
  • antibiotics for PID
  • surgically removing fibroids or polyps
  • eating more iron-rich foods, or taking a supplement

Other surgeries, including uterine artery ablation and hysterectomy, may stop heavy periods if other options do not work. It is important to discuss the risks and benefits of these treatments with a doctor.

If a person experiences tiredness, weakness, or shortness of breath while on their period, it can be a sign they are losing too much blood.

According to the CDC, most people lose around 2–3 tbsps of blood during a period. Heavy periods may cause twice as much blood loss.

If blood often soaks through tampons or pads in less than 2 hours, or a person often passes large clots, they should speak with a doctor. Heavy periods is not something a person has to tolerate, and it may signal an underlying medical condition that needs treatment.

Abundant menstruation. Possible reasons | Kotex®

Expert Comment
Gynecologist Anastasia Degteva

“Heavy periods can not only affect your well-being and plans for the day, but also exacerbate existing health problems, such as iron deficiency anemia.
It is important to exclude the most common causes of heavy menstruation, for example, the presence of polyps, endometrial hyperplasia, endometriosis, uterine fibroids, thyroid dysfunction, increased prolactin, etc. The next step is to ask your gynecologist for a specific therapy to reduce bleeding, which usually includes hemostatic agents, NSAIDs, and hormonal medications. Do not ignore uncharacteristic heavy discharge and consult a doctor immediately!

Menstruation (menstruation) is uterine bleeding, usually lasting from 2 to 7 days and occurring on average once every 25-35 days. Usually, blood loss during menstruation is from 30 to 50 ml, but the norm can be as high as 80 ml. To make it clearer, each fully soaked sanitary napkin or tampon absorbs on average about 5 ml of blood, that is, on average, women spend 6-10 pads or tampons per menstruation.

Abundant periods in the medical sense of the word are considered to be such periods in which the bleeding is so intense that the pad or tampon sometimes has to be changed every hour, that is, use 6-7 pieces a day and which last longer than 7 days. This condition is called menorrhagia and can cause anemia as well as clots larger than 2 cm in diameter. Often, such heavy periods are accompanied by severe cramps that interfere with leading a full-fledged lifestyle.

Signs of menorrhagia:

  • Menses last longer than 7 days

  • Loss of more than 80 ml of blood per cycle

  • Using more than 16 tampons or pads per cycle

  • Leakage or complete soaking of a pad or tampon within 30 minutes

  • Large blood clots (two ruble coin or larger)

  • The need to replace the gasket at night

  • Have to use two pads at once or a pad and tampon to avoid leakage

In addition, menorrhagia may be accompanied by symptoms that may also indicate anemia (a condition in which the hemoglobin and red blood cells are low in the blood):

What are the reasons for heavy periods?

If periods are profuse, prolonged and painful every time

This may be due to the presence of pathologies and changes in the body that you do not know about.

Hormonal imbalance

The female body secretes the hormones progesterone and estrogen, which regulate the menstrual cycle. Excess estrogen can cause the lining of the uterus to thicken, which in turn causes more bleeding during menstruation.

Ovarian dysfunction

The condition when the ovaries do not release an egg (ovulation does not occur) during the menstrual cycle is called anovulation. This is because the body does not produce progesterone as it does during a normal cycle.

Blood clotting disorder

Between 10 and 30% of women with heavy periods suffer from bleeding disorders that can lead to difficulty stopping bleeding.

Uterine polyps

Polyps are small benign growths in the uterus that can increase the amount of blood sheds during menstruation. They can also cause slight bleeding between cycles and after penetrative intercourse. Sometimes polyps can degenerate into malignant tumors, especially in older women, so they are recommended to be removed.

Uterine fibroids

Uterine fibroids are benign tumors in the muscular layer of the uterus. Most often they appear in women of late reproductive age (35-45 years). This is a very common condition that about 80% of women encounter during their lives. Menorrhagia is most often caused by large or numerous fibroids. Most often, fibroids are small and are not accompanied by any symptoms.

Premenopausal

This period is characterized by hormonal changes before menopause, and many women notice an increase in the volume of menstruation

Recovery after childbirth

It is not uncommon for menses to be very heavy after childbirth. In some women, they gradually become what they were before childbirth, but in many they remain plentiful.

Endometrial hyperplasia

Some women may develop a condition in which the endometrium of the uterus becomes too thick. This condition is called endometrial hyperplasia and can cause profuse, prolonged bleeding with blood clots. It most often occurs after menopause, but it sometimes happens to younger women as well.

Adenomyosis

Adenomyosis is a condition in which the endometrium of the uterus grows into the muscular and intermediate layers of the uterus. Most often occurs in women of childbearing age (25-35 years). In the places of germination of the endometrium, inflammatory processes occur. This condition is often difficult to diagnose and its causes are poorly understood.

Other diseases

Heavy periods may also be associated with endometriosis, thyroid disease, pelvic inflammatory disease, kidney disease, liver disease, and cancer.

If menstruation is heavy on the first day

Many women have more intense periods on the first day and then become weaker. However, if you have not experienced this before, you may need to consider whether you have changed oral contraceptives or started taking any other medications that could affect hormone levels.

Once heavy periods

Miscarriage

Often, miscarriages can occur before a woman knows she is pregnant, because at very early stages they can pass like heavy periods.

Ectopic pregnancy

An ectopic pregnancy occurs when a fertilized egg attaches itself outside the uterus. The symptoms of an ectopic pregnancy can easily be confused with heavy menstruation. This condition can be deadly.

If you are pregnant and start to bleed profusely, call an ambulance!

Non-hormonal IUD

Heavy periods are a typical side effect of the use of non-hormonal uterine coils.

Medicines

Blood thinners and anti-inflammatory drugs may cause more heavy menstrual bleeding.

Please remember that heavy menstruation is not always due to some kind of pathology. Every woman’s menstrual cycle is unique and heavy bleeding may just be a feature of your body. However, a large loss of blood can cause excess iron loss and anemia. With mild anemia, you may experience fatigue and weakness. More severe forms can cause dizziness, headache, and heart palpitations. Often heavy periods are accompanied by severe uterine spasms that cause severe pain (dysmenorrhea). Severe pain cannot be tolerated and this condition may require medical treatment.

What can be done at home to relieve heavy periods?

  • If you are in pain, take a nonsteroidal anti-inflammatory drug. You can also apply a heating pad to your abdomen—the heat relieves cramps.

  • Iron-rich foods and iron supplements can help relieve heavy periods and manage iron deficiency in mild anemia.

  • Iron-rich foods such as beef, liver and other offal, turkey, spinach, fish, pumpkin seeds, dried apricots, white beans, cocoa beans, mushrooms. It also makes sense to increase the amount of vitamin C, because it promotes the absorption of iron. A lot of vitamin C is found in kiwi, bell peppers, strawberries, citrus fruits, broccoli, tomatoes, kohlrabi, pineapple.

  • Drink enough water.

If you bleed heavily for several days, your blood volume may drop noticeably. Drink 4-6 extra glasses of water to maintain your blood volume.

Causes of heavy periods, what to do, very heavy bleeding during menstruation with blood clots

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Causes of heavy periods, what to do, very heavy bleeding during menstruation with blood clots

Contents

  • Abundant periods: causes
  • Abundant periods: what to do?
  • Therapeutic tactics

Heavy menstruation (menorrhagia) is one of the types of abnormal uterine bleeding (AMB). Under AUB understand any violation of the menstrual cycle that does not meet the parameters of normal menstruation (too long, heavy or frequent uterine bleeding). The causes of heavy bleeding during menstruation can be gynecological and extragenital. The appearance of very heavy periods requires a full examination of the patient, identification of the cause and its subsequent elimination.

HEAVY PERIOD: CAUSES

In modern gynecology, all factors contributing to the appearance of menorrhagia are included in the PALM-COEIN classification. It combines a number of gynecological pathologies and diseases of other localizations. Abundant periods with clots according to PALM-COEIN may be due to the following reasons:

  • P – uterine polyp.
  • A – adenomyosis (endometriosis).
  • L – uterine leiomyoma.
  • M – malignancy and hyperplasia.
  • C – coagulopathy.
  • O – ovulatory disorders.
  • E – endometrial changes.
  • I – iatrogenic ovulatory dysfunction.
  • N – still unknown cause due to incomplete diagnosis or impossibility to conduct a full-fledged study. 1

The first four diseases cause heavy periods with blood clots in women of older reproductive age and practically do not occur in adolescents and young girls. Coagulopathy, on the contrary, is most often observed in 20% of adolescents and 10% of women. Under coagulopathy understand disorders in the blood coagulation system, which are manifested by hemorrhagic syndrome (increased bleeding) of varying severity. Coagulation disorders are observed in hemophilia, von Willebrand disease and taking certain drugs (anticoagulants and antiplatelet agents). 1 Causes of heavy periods with clots can also be associated with endocrinopathies and disorders of the regulation of the menstrual cycle by the central nervous system. This group includes:

  • Prolonged neuropsychic stress.
  • Overweight or underweight, including rapid weight gain or weight loss.
  • Uterine leiomyoma.
  • Significant physical activity.
  • Changes in thyroid function.

A common cause of heavy periods with large clots is endometriosis – an abnormal growth of endometrioid tissue (the inner layer of the uterine wall). This tissue is sensitive to the action of sex hormones and is rejected by the same mechanism as the endometrium of the uterus during menstruation. Clinically, endometriosis is manifested by profuse and prolonged bleeding, pelvic pain and inability to conceive a child.

HEAVY PERIOD: WHAT TO DO?

The only right decision is to seek qualified gynecological care. Only a doctor can determine the cause and type of abnormal uterine bleeding. The AUB diagnostic algorithm includes two stages. The first is the collection of complaints and anamnesis. According to statistics, about 50% of women with complaints of heavy menstrual bleeding do not actually have them, and 25% of patients without complaints suffer from AUB3. An indicator of menorrhagia is the release of blood in the form of clots, the use of ultra-absorbent pads, or the simultaneous use of several hygiene products (tampon , pad, menstrual cup). A clinical sign of heavy uterine bleeding is also the need to change the hygiene product more often than 1 time in 2 hours, the presence of traces of blood on the bed linen after sleep

At the second stage, differential diagnosis is carried out among all possible causes and the leading one is identified. For this, the following are used:

  • General, bacteriological and oncocytological smears.
  • Determination of hormonal status.
  • Screening for sexually transmitted infections.
  • Colposcopy and hysteroscopy.
  • Complete blood count.
  • Ultrasound examination of the pelvic organs.
  • Consultation with a hematologist and examination ordered by a specialist.

The scope of the diagnostic program is determined individually. In some cases, a standard gynecological examination of the patient (smears, blood tests and ultrasound) is sufficient, while in others, advanced diagnostics are required. 3

THERAPEUTIC TACTICS

AUB therapy is carried out in several stages. The main task is to get rid of heavy menstrual bleeding and prevent their recurrence. For this purpose, the following are used:

Medical methods of hemostasis – antifibrinolytic agents, non-steroidal anti-inflammatory drugs and combined oral contraceptives. Conservative treatment is used in adolescents and women of young reproductive age without pathological changes in the endometrium.

Surgical hemostasis – separate diagnostic curettage of the mucous membrane of the cervical canal and uterine cavity, followed by histological examination. The method is used in patients of older reproductive age. To prevent recurrence, general strengthening measures are used: vitamin therapy, normalization of work, sleep and nutrition. During menstruation, non-hormonal hemostatic therapy is performed with antifibrinolytic or non-steroidal anti-inflammatory drugs. 2

For patients who need contraception, it is preferable to prescribe combined oral contraceptives on an ongoing basis. They provide control of the menstrual cycle, significantly reduce blood loss and pain, and also prevent the appearance of endometrial hyperplasia.

References:

  1. Ministry of Education and Science of the Russian Federation. Principles of diagnosis and treatment of abnormal uterine bleeding.