What Is Heavy Bleeding
Heavy menstrual bleeding is excessive and/or prolonged menstrual bleeding. The amount varies from woman to woman and can change at different stages in your life for example, in teenage years or approaching menopause. It is defined as blood loss greater than 80ml per cycle, or periods lasting more than seven to eight days. Heavy menstrual bleeding affects about one in five women and is a common problem in the 30-50-year-old age group.
Heavy bleeding fact sheet
How Is Heavy Menstrual Bleeding Diagnosed
Your healthcare provider will ask a series of questions about your medical history and menstrual cycle to diagnose heavy menstrual bleeding.
Your provider may ask about:
- Your age when you got your first period.
- The number of days your period lasts.
- The number of days your period is heavy.
- Family members with a history of heavy menstrual bleeding.
- Your pregnancy history and current birth control methods.
- Current medications you’re taking, including over-the-counter ones.
Come prepared to talk about your quality of life, too. Your provider needs to know if you’ve been doubling up on menstrual products, avoiding activities or placing restrictions on your life in any way because of heavy periods.
How Is Menorrhagia Treated
Your healthcare provider will consider your age and overall health and your personal preferences when finding the best treatment for you.
Treatment for hormone problems may include:
- Prostaglandin inhibitors. These are nonsteroidal anti-inflammatory medicines , including aspirin or ibuprofen. They help reduce cramping and the amount you bleed.
- Birth control pills. These stop ovulation and result in lighter periods.
- Progesterone. This is a type of hormone treatment.
Treatment for problems with the uterine lining may include:
- Ablation. Healthcare providers use this procedure to destroy the lining of the uterus .
- Resection. In this procedure, the lining of the uterus is removed.
- Hysterectomy. This is the surgical removal of the whole uterus.
- Iron supplements. If you have anemia as a result of the heavy loss of blood, you may need iron supplements.
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When Should You Seek Help From Your Healthcare Provider About Your Period Heaviness
If your period amount is regularly over 80 mL, your period is longer than 8 days in length, or if your menstrual flow is so heavy that you are repeatedly soaking through a pad or tampon every two hours, this is considered heavy menstrual bleeding, and should be discussed with your healthcare provider . This type of excessive menstrual bleeding can impact a personâs quality of life and can cause anemia . Heavy menstrual bleeding can have many potential causes including: fibroids , adenomyosis , problems with blood clotting , uterine polyps , and tumors .
If your period has stopped and you are not taking any form of hormonal contraceptive, you should also discuss this with your healthcare provider, as you could be pregnant.
Even if your period falls out of the âofficialâ typical range, itâs important to know what is ânormalâ for you. The majority of health research is conducted on populations from western industrialized countries, which may not reflect your own personal genetic background or environment. Everybody is different, just as everyone’s period is different. Speak to your healthcare provider if you are concerned about your period volume.
What Is Heavy Menstrual Bleeding
Heavy menstrual bleeding is when your periods are extremely heavy or prolonged. “Heavy” means that your period lasts longer than seven days or that you lose more blood than is typical during menstruation. You may bleed so much that you have to change your tampon or pad every hour for several hours back-to-back. You may pass blood clots the size of a quarter or even larger.
Menstrual bleeding that’s so heavy that it interferes with your daily life is never normal. Your provider can recommend treatments to manage heavy blood flow.
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How Long Is Too Long For A Period During Perimenopause
The road to menopause comes with many changes. Night sweats, hormonal imbalances, and vaginal dryness are a few of the well-known symptoms of perimenopause. Heavy, painful periods are also a symptom thats quite common roughly 25 percent of women report experiencing them. Read on to learn the basics of perimenopause bleeding and how to manage extended perimenopause periods.
How Can You Tell If You Have Heavy Menstrual Bleeding
There are some common symptoms and signs that may indicate your flow is heavy, so if youre experiencing one or more of the below, its possible you might have HMB:
- You soak through one or more tampons or pads an hour for several hours in a row.
- You have to use two kinds of period products, like a tampon and a pad at the same time.
- You have to get up at night to change your period products.
- You pass blood clots that are 1 inch or larger during your periods.
- Your periods soak through your bedding or clothes.
- You have to restrict your everyday activities because of heavy menstrual bleeding.
- You experience symptoms and signs of iron-deficiency anemia, including shortness of breath, fatigue, or tiredness.
The average person loses between 30 and 40 milliliters, or two to three tablespoons, of blood during menstruation. However, people suffering from HMB can lose up to 80 milliliters each month.
To give you an idea of how much 80 milliliters is, a menstrual cup can hold up to around 30 milliliters of menstrual blood a regular-absorbency tampon absorbs up to five milliliters and a standard pad absorbs about 15 milliliters.
Measuring blood loss can be tricky because your menstrual fluid also contains a mix of mucus and uterine tissues, which can add to the volume of your overall fluid loss. One way to work out if you have HMB is to measure your flow. Speak to your health care professional about the best way to do this.
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Let It Bleed: Causes Of Heavy Periods
In the developed world, girls now get their periods earlier, and women spend less time being pregnant and breast feeding on demand. This means that the average women can now expect to have more than 400 menstrual cycles in their lifetime . Even the use of most hormonal contraceptives will yield a monthly bleed. So its no wonder that women are so concerned when their cycles seem to be longer and heavier than usual.
To address the most-pressing question, When should I be concerned? What is the medical definition of too much bleeding?, there is a medical definition of too-heavy periods. If a woman is bleeding 80cc or more, that is excessive bleeding. Trying to measure exactly the amount of bleeding is difficult even in a research setting, much less in a home bathroom! Some general indications of excessive bleeding can include:
- Saturating a maxipad or super tampon every 60-90 minutes for several hours
- Passage of large clots
- Significant bleeding for more than seven days
Probably the most important factor would be if your bleeding is heavy enough to interfere with your normal activities.
There are two major reasons for very prolonged/heavy periods: hormonal and what I call structural. Here at WebMD we get questions about prolonged and heavy bleeding just about every day, so it seems like a good time to share information about some of the causes of too-heavy periods and other types of abnormally heavy vaginal bleeding.
Hormonal Causes
The Shot And The Implant
Methods like the contraceptive injection and the implant suppress ovulation . Most people who donât ovulate due to these progestin-only contraceptives experience shorter, lighter, or occasionally absent bleeding days, though this doesnât always happen .
Unpredictable bleeding, spotting, and prolonged bleeding are common when using these methods, especially during the first few months . These symptoms usually improve with time, but they can continue for some people.
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Period Bleeding Thats Cause For Concern
Your daughter probably doesnt want to discuss her periodwith you. But talk to her if you notice that she:
- Is going through a huge stack of pads each month
- Has periods that last longer than 10 days
- Has heavy bleeding throughout her entire period
If she does have a bleeding disorder, you might notice theseother signs as well:
- Blood loss when a baby tooth fell out or whilebrushing teeth
- History of significant bleeding during minorsurgery
- Family history of bleeding disorders or heavyperiods
Some unlucky women just have heavier periods than others. But if you have any concerns, its worth taking your teen to see a doctor even if it means risking some heavy-duty eye rolling.
Endometrial Hyperplasia And Cancer
Endometrial hyperplasia, which is the overgrowth and thickening of the endometrium, can cause heavy period flow.
It is due to unopposed effects of estrogen especially in women taking hormone replacement or diseases like polycystic ovarian syndrome. Symptoms are:
- Bleeding or spotting between period
- Sometimes extremely heavy periods
If your heavy period is due to cancer, then you may experience any of these symptoms
- Vaginal heavy bleeding
- Pain during sexual intercourse
Both endometrial cancer and hyperplasia is usually common in women over the age of 40. Your chances to have cancer increases if youre
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Check If You Have Heavy Periods
You may have heavy periods if you:
- need to change your pad or tampon every 1 to 2 hours, or empty your menstrual cup more often than is recommended
- need to use 2 types of sanitary product together, such as a pad and a tampon
- have periods lasting more than 7 days
- pass blood clots larger than about 2.5cm
- bleed through to your clothes or bedding
- avoid daily activities, like exercise, or take time off work because of your periods
- feel tired or short of breath a lot
Hormone And Ovulation Changes
Changes to your hormones or ovulation may cause a long period. You may notice hormonal changes when you first get your period during puberty or in perimenopause. You may also experience a hormonal imbalance from different health conditions, such as thyroid disorders or polycystic ovary syndrome.
If your hormones arent at a normal level or if your body doesnt ovulate during your menstrual cycle, the uterine lining can become very thick. When your body finally sheds the lining, you may experience a period thats longer than normal.
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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 thats 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.
Reasons Your Period Is Heavier Than Usual
From no-biggie birth control changes to serious medical problems.
When it comes to menstruation, not all periods are created equal. Any Mean Girls fan knows that some women just have a heavy flow and wide-set vagina! And while you shouldnt worry if you typically use super tampons while your friends always grabbing the light ones, something might be up if your flow has dramatically changed and is now heavier than it usually is.
Women are definitely aware of whats normal for them, says ob-gyn Jennifer Ashton, M.D. If one of my patients is experiencing something irregular and it happens three months in a row, I like to see her.
From no-biggie birth control changes to serious medical problems, here are seven reasons why you might be bleeding more than usual.
Considering that hormonal birth-control pills often regulate and lessen periodsin fact, some doctors prescribe it specifically to lighten up heavy flowsit makes sense that if you switch to a non-hormonal pill or stop taking oral contraception completely, youre going to be going through your tampons faster. And although IUDs like Mirena also lighten periods, Ashton says that non-hormonal IUDs tend to cause heavier periods in most women. While this is generally normal, see a healthcare professional if your heavy bleeding continues three months after insertion.
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What Causes Heavy Bleeding
About 50% of women with heavy menstrual bleeding have no abnormalities in their uterus. It might be related to hormonal or chemical levels in the endometrium or conditions not yet identified in the endometrium.
In the other 50% of cases, the cause might be related to:
- Pregnancy or complications of pregnancy please contact your doctor if you have bleeding during pregnancy.
- Polycystic ovary syndrome some women can have heavy menstrual bleeding if the lining of the uterus is thickened this can lead to pre-cancerous or cancerous changes.
- Endometriosis occurs when tissue similar to that found in the lining of the uterus grows outside of it.
- Endometrial polyps usually non-cancerous growths in the endometrium that look like a large ‘teardrop’ of tissue.
- Endometrial hyperplasia an overgrowth of the endometrium, which can progress to cancer.
- Endometrial cancer cancer of the uterus.
- Adenomyosis endometrium growing in small pockets inside the muscle layer of the uterus.
- Fibroids non-cancerous growths or lumps within the uterus wall.
- Intrauterine device a contraceptive device.
There is a range of other possible causes that are not as common, such as:
- hormonal disorders, such as an underactive thyroid gland
- bleeding disorders in which excessive bleeding can occur, such as Von Willebrand disease
- chronic kidney or liver disease.
A Period Thats Heavy On The First Day
Many women experience heavier bleeding on the first day of a period and lighter bleeding on the last days. A heavy flow that might get in the way of your normal activities is unusual.
Birth control changes
If you recently stopped using hormonal birth control, your periods may be very heavy in the first days as your cycle adjusts to the hormone changes.
Medication changes
Like birth control, medications you take may interfere with your cycle and lead to heavy bleeding on the first day of your period.
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Possible Consequences Of Heavy Menstrual Bleeding
Whenever you have a period, you lose blood. For those with normal bleeding, anda diet containing normal amounts of iron, blood loss and iron intake should bein balance. However, for those with heavy menstrual bleeding, and especiallywhen the diet is deficient in iron, blood loss can exceed iron intake and mayresult in an iron deficiency and possible low red blood count, or anemia. Iron deficiency, with or without anemia, can cause fatigue and interfere with the ability to concentrate, exercise, and, enjoy life in general.
How Do I Know If My Periods Are Heavy
Heavy periods refers to heavy or prolonged blood loss that interferes with your quality of life. This could mean any of the following:
- you need to change your tampon or sanitary pad every hour
- blood leaks through to your clothes and bedding
- you need to change a pad overnight
- you pass blood clots larger than a 50 cent coin
- you bleed for more than 7 to 8 days
- the amount of blood loss causes you to stay home, affects your daily activities or makes you feel stressed
If heavy periods are affecting your everyday life, you can speak to your doctor about it. Your doctor can arrange tests to check for any health conditions that may be causing your heavy bleeding.
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Symptoms Of Abnormal Uterine Bleeding
Symptoms include:
- bleeding for more than eight days
- heavy blood loss during the menstrual period for example, soaking through one or more sanitary pads or tampons every hour for several hours in a row
- needing to change your pad or tampon during the night
- have to change or restrict your daily activities due to your heavy bleeding
- bleeding or spotting between periods
- cramping and pain in the lower abdomen
- any vaginal bleeding after menopause.
If you think you may be experiencing heavy menstrual bleeding, you may find it useful to keep a pictorial blood loss assessment chart this can help you give your doctor an idea of how heavy your period is.
How Long Are Normal Perimenopause Periods
Ordinarily, your menstrual cycle occurs every 21 to 35 days and lasts from 2 to 7 days. However, perimenopause periods can last much longer. Some months, the ovaries might not produce sufficient levels of estrogen and progesterone, preventing menstruation altogether. Other months, the imbalance might cause the uterine lining to become overly thick, which means it will take longer to be shed by your body to shed.
Excessive bleeding and long periods are fairly common during perimenopause. Many women experience an increased flow and extended perimenopause periods before entering menopause.
If youve had periods that are several days longer or more frequent or heavier than usual, its a good idea to see your doctor.
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