Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosis
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Chronic (prolonged) or heavy periods can lead to complications such as iron-deficiency anemia. Fortunately, heavy periods can be treated with medication, contraceptives, and surgery.
This article discusses the symptoms and causes of heavy menstrual bleeding. It defines normal and heavy periods. It also explains when you should talk to yourgynecologistand when emergency medical care may be required.
Verywell / Brianna Gilmartin
Signs You’re Losing Too Much Blood During Period
A typical period lasts four or five days. During that time, an individual sheds 2 to 3 tablespoons of blood. Those with heavy menstrual bleeding can lose twice as much blood each month.
These are signs that you’re losing too much blood during your period and should see a healthcare provider:
When Menstrual Bleeding Is an EmergencyGo to the nearest emergency room if you experience severe, acute bleeding in which you soak through four or more pads or tampons in a two-hour period.If you are pregnant, seek medical care if you have any bleeding.
When Menstrual Bleeding Is an Emergency
Go to the nearest emergency room if you experience severe, acute bleeding in which you soak through four or more pads or tampons in a two-hour period.If you are pregnant, seek medical care if you have any bleeding.
What Causes Heavy Menstrual Bleeding?
There are a number of different causes of heavy menstrual bleeding—including benign (noncancerous) growths, like fibroids, or malignant growths, like cancer of the uterus or cervix. Hormone changes or blood clotting disorders can cause heavy menstrual bleeding too.
Other less common causes of heavy menstrual bleeding include endometriosis and having anintrauterine device (IUD)like theParaGard, which may cause excessive bleeding, especially during your first year of use.
But the list does not stop there. That’s why it’s important to see a healthcare provider for a proper diagnosis and evaluation.
Understanding Chemical Pregnancy: What Causes Early Miscarriage?
Ovulatory Dysfunction
The most common cause of heavy menstrual bleeding is ovulatory dysfunction during adolescence orperimenopause.During this time, ovulation (releasing an egg) can be irregular—which means it might not happen every month. This can lead to thickening of the endometrium (uterine lining) and heavy periods.
Oral contraceptives can usually regulate your bleeding during adolescence, and hormone therapy can help during menopause.
Beyond the normal hormonal changes that occur with puberty or menopause, hormonally-induced ovulatory dysfunction can also occur with:
Getting treated for your underlying problem is important, and it can help restore regular ovulation and normalize your periods.
Uterine Fibroids
Fibroids are growths that develop from the muscle of the uterus, usually between the ages of 30 and 49.
Uterine fibroidsneed estrogen to grow.Hormonal birth control methods, like birth control pills, can help reduce heavy menstrual bleeding from fibroids.
If your symptoms are not severe or troublesome, you might not need treatment for your fibroids—it’s often sufficient to take a “wait and see” approach. During menopause, fibroids typically shrink without treatment.
Some of the treatments for uterine fibroids include the following:
In the most severe cases, ahysterectomymay be warranted, in which the uterus is removed, with or without the ovaries.
Uterine Polyps
Endometrial polyps are typically noncancerous, grape-like growths that protrude from the lining of the uterus. They can develop before and after menopause. The cause of endometrial polyps is unclear, though research suggests a link betweenhormone therapyand obesity.
Treatment of small polyps is unnecessary unless it contributes to symptoms or you’re at risk of uterine cancer. If you are, your healthcare provider might recommend apolypectomy, in which the polyp would be removed for microscopic examination. Large polyps are routinely removed and examined as a precaution.
Uterine Adenomyosis
Uterine adenomyosisis a condition in which the endometrial uterine cells grow into the muscular wall of the uterus, causing uterine enlargement and painful, heavy bleeding. Hormonal birth control methods can help control the condition, and the definitive treatment for adenomyosis is a hysterectomy.
Pelvic Inflammatory Disease (PID)
Cervical or Endometrial Cancer
Endometrial cancer occurs when abnormal cells in the endometrium grow into the uterus and/or other organs. While the cause of endometrial cancer is unknown, the most common age for diagnosis is the mid-60s.
Early diagnosis is key to the effective treatment of cancer. In addition to regularPap screeningfor cervical cancer, the American Cancer Society recommends that women at high risk of endometrial cancer have an annual endometrial biopsy.
Bleeding Disorders
While there are several types of bleeding disorders, the most common type in women isvon Willebranddisease(VWD).Treatments for von Willebrand disease involve releasing stored clotting factors in the blood or, in extreme cases, replacing the clotting factor with an intravenous or a prescribed nasal spray.
Other bleeding issues that can lead to heavy menstrual bleeding include:
Pregnancy Complications
Early pregnancy complications can cause heavy bleeding that mimics period bleeding. The most common are:
Certain Medications
Certain medications may cause heavier menstrual bleeding. Some examples include:
When to Call a Healthcare Provider
It’s important that you get a diagnosis for the cause of your heavy menstrual bleeding. Before your appointment, jot down your period pattern in the last few months.
For instance, how many days did you bleed each month? How many pads or tampons do you go through on the days of your heaviest menstrual flow?
Make sure you have a list of all your medications, including hormonal birth control, hormone therapy, and any vitamins or over-the-counter supplements.
You might have diagnostic tests, such as:
Your healthcare provider may also do a hysteroscopy, a diagnostic procedure used to visualize the inside of your uterus. They may also do an endometrial biopsy to sample your uterine tissue for microscopic examination.
Summary
Heavy menstrual bleeding is also called menorrhagia. If you bleed for seven or more days, need to change your pad or tampon every hour, or are producing large blood clots, you may be experiencing heavy menstrual bleeding.
Heavy menstrual bleeding can have a number of possible causes, including problems with the ovaries, uterine fibroids, pelvic inflammatory disease, and others. Certain medications may also cause you to bleed more heavily than usual.
If you experience heavy menstrual bleeding, it is important to see your healthcare provider for a diagnosis.
16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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