What causes heavy periods?. How to identify menorrhagia symptoms. Diagnosing the underlying cause of heavy menstrual bleeding.

Understanding Menorrhagia: What is Heavy Menstrual Bleeding?

Menorrhagia, also known as heavy menstrual bleeding, is a condition where a woman experiences abnormally heavy or prolonged periods. This type of excessive uterine bleeding can have a significant impact on a woman’s quality of life, leading to discomfort, disruption of daily activities, and even potential health complications if left untreated.

Causes of Heavy Periods: Identifying the Underlying Factors

There are several potential causes of menorrhagia, including:

• Life Changes: Significant life events, such as pregnancy, childbirth, or the transition to menopause (perimenopause), can trigger changes in hormone levels that lead to heavier periods.
• Medication and Birth Control: Certain medications, particularly blood thinners, and some forms of birth control (e.g., copper or hormonal IUDs) can contribute to heavy menstrual bleeding.
• Hormone Imbalances: An imbalance in estrogen and progesterone levels can cause the uterine lining to thicken, leading to heavier bleeding during menstruation.
• Uterine Fibroids: Noncancerous growths within the uterus, known as fibroids, can increase the surface area of the uterine lining, resulting in heavier periods.
• Endometriosis: This condition, where the uterine lining grows outside the uterus, can also lead to heavy, painful periods and shorter menstrual cycles.

Recognizing the Symptoms of Menorrhagia

Determining whether your menstrual bleeding is considered heavy can be challenging, as each woman’s “normal” flow may vary. However, the American College of Obstetricians and Gynecologists suggests the following as potential signs of menorrhagia:

• Bleeding for more than seven days
• Needing to change a tampon or pad every hour or less
• The need to use both a tampon and a pad to control bleeding
• Passing blood clots larger than a quarter

If left untreated, heavy menstrual bleeding can lead to anemia, causing symptoms such as fatigue, lightheadedness, and shortness of breath.

Diagnosing the Underlying Cause of Menorrhagia

Diagnosing the root cause of heavy menstrual bleeding involves a two-step process:

1. Confirming Heavy Bleeding: Your healthcare provider will review your medical and menstrual history to confirm that your bleeding is indeed unusually heavy.
2. Identifying the Underlying Cause: Various tests may be conducted, such as blood tests, Pap smears, endometrial biopsies, and ultrasounds, to identify any underlying conditions that could be contributing to the heavy bleeding.

By identifying the specific cause of your menorrhagia, your healthcare provider can develop an appropriate treatment plan to address the issue and alleviate your heavy menstrual bleeding.

Treatments for Menorrhagia: Restoring Normal Menstrual Cycle

The treatment approach for heavy menstrual bleeding will depend on the underlying cause. Some common treatment options include:

• Hormonal Therapy: Oral contraceptives, progestin-only medications, or hormone-releasing intrauterine devices (IUDs) can help regulate hormone imbalances and reduce heavy bleeding.
• Antifibrinolytic Medications: Drugs that help prevent the breakdown of blood clots can be effective in reducing heavy menstrual flow.
• Surgical Interventions: For conditions like uterine fibroids or endometriosis, surgical procedures such as myomectomy (removal of fibroids) or endometrial ablation may be recommended to address the underlying cause.

By working closely with your healthcare provider, you can explore the most appropriate treatment options to manage your heavy menstrual bleeding and restore your menstrual cycle to a more normal and manageable state.

Seeking Professional Help for Menorrhagia

If you are experiencing heavy or prolonged menstrual bleeding, it is important to consult with a healthcare provider, such as an obstetrician-gynecologist (OB/GYN). They can perform the necessary evaluations and tests to determine the underlying cause of your menorrhagia and develop a tailored treatment plan to address the issue.

Conclusion

Menorrhagia, or heavy menstrual bleeding, can significantly impact a woman’s quality of life. By understanding the potential causes, recognizing the symptoms, and seeking professional medical guidance, women can take the necessary steps to manage their heavy periods and restore a more normal menstrual cycle. With the right diagnosis and treatment, the majority of women with menorrhagia can find effective solutions to address this common, yet often underreported, condition.

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 periods: ignore, tolerate or correct? | Verum

Heavy periods: ignore, tolerate or fix?

“Are you afraid of a leak? Don’t wear white and tight, dance while sitting…” – the commercial for hygiene products with humor and very accurately describes the situation that many women face on a monthly basis. There is only one small inaccuracy in it: the problem of heavy periods cannot and should not be solved only with the help of tampons and pads, no matter how superabsorbent they are.

Heavy menstruation at any age is a reason to consult a gynecologist, because according to modern approaches, heavy menstruation is either a sign of a disease requiring treatment (abnormal uterine bleeding) or a special condition, again requiring treatment (heavy menstrual bleeding ).

Let’s see why.

First, we need to decide whether we are objective in assessing menstruation as heavy (studies have shown that more than 60% of women either exaggerate or underestimate their menstrual blood loss).

So, which periods are considered heavy?

The average amount of blood a woman loses during her entire menstrual period is 30-50 ml (maximum 80 ml). Under normal conditions, counting in milliliters is not possible, so special visual analog scales have been developed in which a woman indicates the number of pads or tampons and the degree of their wetting.

In addition, there are signs of heavy menstruation, these are:

• the need to change a pad or tampon every hour for several hours in a row;
• changing pads at night;
• using more than one pad, tampon and pad at the same time;
• duration of menses more than 7 days;
• large blood clots on a pad or swab;
• great fatigue, weakness during menstruation.

They are less objective than the scales, but may well serve as a reason to visit a gynecologist.

What is the basis of heavy menstruation and what are their causes.

The main known causes of excessive blood loss during menstruation are: impaired ability of the uterine muscle to contract, impaired growth and rejection of the inner layer of the uterus (endometrium), changes in the ability of blood to clot.

Heavy menstruation can be caused by:

• a group of functional causes – various ovarian dysfunctions (violation or absence of ovulation), leading to an imbalance of sex hormones, under the influence of which cyclic changes in the endometrium occur. In turn, the causes of ovarian dysfunction can be thyroid problems, elevated prolactin, polycystic ovary syndrome and other systemic hormonal disorders
• diseases of the uterus (uterine fibroids, adenomyosis or endometriosis of the uterus, anomalies in the development of the uterus) and endometrium (hyperplasia, polyp). All these diseases can be seen, for example, on ultrasound, so they are called anatomical or structural.
• and, finally, at first glance, such diseases of the blood, far from gynecology, accompanied by a violation of its coagulation;

If the gynecologist during the examination reveals one or more of the above reasons in a woman, a diagnosis will be made “Abnormal uterine bleeding” . Treatment will be carried out according to the cause.

However, it is not uncommon for a gynecologist to find none of these causes in a woman with objectively confirmed heavy periods. In such a situation, diagnosis “Heavy menstrual bleeding” is eligible. This is when, in the absence of hormonal dysfunction or organic (tumor / trauma / developmental abnormalities) pathology, a woman experiences discomfort associated with heavy menstruation, her quality of life decreases. For example, a woman lawyer cannot hold a court session without going to the ladies’ room, a woman surgeon – an operation, a woman sports instructor – training. Heavy menstrual bleeding does not necessarily lead to anemia. Thus, TMK is a kind of feature of the body of some women. A feature that deserves medical attention and help. Today, in the arsenal of gynecologists there are effective non-hormonal drugs for the treatment of heavy menstrual bleeding.

Why should I not delay examination and treatment for heavy periods?

Abundant menstruation is a common cause of chronic iron deficiency anemia, leading to oxygen starvation of organs and tissues of the whole organism.

As already mentioned, the most common causes of abnormal uterine bleeding are ovarian dysfunction and diseases of the uterus and endometrium. Without treatment, all these conditions lead to serious consequences: in themselves, ovarian dysfunction can cause the development of benign and malignant diseases of the uterus, endometrium, mammary glands, impaired libido; endometrial hyperplasia carries a high risk of transition to endometrial cancer; uterine fibroids that have reached a large size are more difficult to remove, and so on. Abnormal uterine bleeding is an important signal, neglecting which you can miss the chance of effective treatment of the underlying disease.

What if it’s my family?

A common and dangerous misconception : my mother and sister also always had heavy periods, so it makes no sense for me to be examined and treated, I just need to endure.

Many causes of abnormal uterine bleeding may have a hereditary component (endometriosis, tendency to heavy menstrual bleeding). But (!), this does not mean that you do not need to be treated. Yes, in the days of our mothers and grandmothers there was often no effective treatment, but now it is!

Or maybe it’s just such an age period and with time everything will come back to normal?

Another common and dangerous misconception . Violations of the cycle, accompanied by heavy menstruation, are indeed characteristic of certain age periods: the formation of menstrual function and the extinction of ovarian function (transition to menopause), but this again does not exclude the need for examination to determine the cause of bleeding . After all, oncological causes are not excluded!

What examinations should be done to determine the cause of heavy menstruation?

The gynecologist develops an individual examination plan for each woman, depending on the characteristics of her complaints, medical history and initial examination. As a rule, examination for abnormal uterine bleeding includes: gynecological examination, ultrasound of the pelvic organs, hormonal examination, blood test. According to the indications, the following can be recommended: hysteroscopy (examination of the uterine cavity using a special apparatus equipped with a camera and sampling of material for histological examination), MRI.

How effective is the treatment for abnormal uterine bleeding?

Abnormal uterine bleeding is treated according to the diagnosed cause. With submucosal uterine myoma, polyps or endometrial hyperplasia – hysteroscopic resection with histological examination and corresponding anti-relapse therapy. In case of violation of ovulation – correction of hormonal dysfunction (not necessarily with the use of hormonal drugs). Treatment of abnormal uterine bleeding is effective!

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