If you bleed a lot during your menstrual cycle, you're not alone. Many women do. For some women, having heavy menstrual periods (also called menorrhagia) means passing large blood clots and changing sanitary pads and tampons often.
What causes heavy periods?
Several things can cause heavy periods. These may include:
A change in hormones. Normally one of your ovaries releases an egg during your menstrual cycle. This is called ovulation. When you don't ovulate, your hormone levels can get out of balance. When this happens, it can affect the lining in your uterus and may cause heavy bleeding.
An irritation in the uterus. Certain things can cause this to happen, such as using a copper intrauterine device (IUD).
Sometimes a cause for your bleeding can't be found.
In most cases, having heavy periods isn't serious. But it can affect your daily activities. In rare cases, heavy periods may mean that you have a more serious problem, such as an infection, an unknown pregnancy, or cancer.
What are the symptoms?
When you have heavy periods, you may pass large blood clots and soak through your usual pads or tampons. You may also have periods that last longer than 7 days.
When you lose a lot of blood during your period, your iron levels can drop. This can cause anemia. Anemia can make you feel tired, weak, and short of breath.
How are heavy periods diagnosed?
Your doctor will ask about your symptoms and menstrual periods. You'll have a pelvic exam. To get a closer look, your doctor may also do an ultrasound or another type of test that shows the lining of your uterus. Sometimes a tiny sample (biopsy) of tissue is taken from your uterus to look for infection and abnormal cell changes.
Your doctor may also do blood tests to check for anemia or other problems.
How are they treated?
Your doctor may recommend medicine or hormone treatments to slow or stop your periods. If these treatments don't help, you may need surgery to help control your menstrual bleeding.
If a growth, such as a polyp or fibroid, is causing your heavy periods, your doctor may recommend surgery or other treatments to remove the growth. This can help reduce or stop heavy bleeding.
Because blood loss from heavy periods can make you feel very tired and weak (anemic), your doctor may recommend that you take extra iron.
In most cases, heavy menstrual periods can be managed with:
Medicine to reduce bleeding.
Hormone therapy to either stop your periods or make them more regular.
But if these treatments don't work, surgery may be needed to control your bleeding.
If you plan to become pregnant in the future, or if you're nearing the time when your periods will stop (menopause), you may want to try medicine first.
Hormone treatments that are used to help control heavy bleeding include:
Birth control pills, patch, or ring. These types of birth control give you a regular dose of estrogen and progestin. They control your body's menstrual cycle and prevent pregnancy. They also help relieve heavy menstrual bleeding and pain. For example, when you take birth control pills, your menstrual bleeding may be half as heavy as it was before you took the pills. But when you stop taking the pills, heavy bleeding may return.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as over-the-counter ibuprofen (Advil and Motrin, for example), also can help. They lower prostaglandins, which cause menstrual pain, and they reduce bleeding during your period. Be safe with medicines. Read and follow all instructions on the label.
Because blood loss from heavy menstrual periods can make you feel very tired and weak (anemic), your doctor may want you to take extra iron.
A medicine called tranexamic acid (such as Lysteda) is sometimes used for women who have bleeding that is heavier than normal. This medicine isn't a hormone. It prevents bleeding by helping blood to clot. Talk with your doctor to find out if this option is right for you.
If medicine doesn't help, or if you have a growth in your uterus (such as a polyp or fibroid), you may need surgery or another procedure to help control your menstrual bleeding.
The following procedures are used to treat heavy menstrual periods:
Hysteroscopy can be used to diagnose heavy periods and treat them at the same time. A lighted viewing tool called a hysteroscope is inserted through the vagina and cervix and into the uterus.
Endometrial ablation is a procedure that destroys (ablates) the uterine lining, or endometrium. Sometimes a hysteroscope is used to see inside the uterus. This procedure can help reduce or prevent uterine bleeding. Endometrial ablation is not a treatment option if you're planning to become pregnant.
Hysterectomy is the removal of the uterus. It's a major surgery. It's sometimes used when uterine bleeding can't be controlled or when the cause of chronic bleeding can't be found and treated.
If heavy menstrual periods are affecting your daily life, you're no doubt looking for relief. Here are some things you can do on your own to ease your symptoms:
Take a nonsteroidal anti-inflammatory drug (NSAID), such as over-the-counter ibuprofen (Advil and Motrin, for example), to reduce pain and bleeding during your period. An NSAID works best when you start taking it 1 to 2 days before you expect pain to start. If you don't know when your period will start next, take your first dose as soon as bleeding or premenstrual pain starts. Be safe with medicines. Read and follow all instructions on the label.
Take iron supplements or a multivitamin if your iron levels are low and if your doctor says that it's okay. Heavy menstrual periods can cause your iron levels to drop, which can cause anemia. You can prevent anemia by increasing the amount of iron in your diet. Eat a balanced diet that is high in iron and vitamin C. Foods rich in iron include red meat, shellfish, eggs, beans, and leafy green vegetables.
Lentz GM (2012). Primary and secondary dysmenorrhea, premenstrual syndrome, and premenstrual dysphoric disorder. In GM Lentz et al., eds., Comprehensive Gynecology, 6th ed., pp. 791–803. Philadelphia: Mosby.
Lobo RA (2012). Abnormal uterine bleeding: Ovulatory and anovulatory dysfunctional uterine bleeding, management of acute and chronic excessive bleeding. In GM Lentz et al., eds., Comprehensive Gynecology, 6th ed., pp. 805–814. Philadelphia: Mosby.
Sarah Marshall, MD - Family Medicine
Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology
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