Why is my period so heavy?

If you’re experiencing heavy menstrual bleeding, take heart in knowing that more than 10 million women in the U.S. each year grapple with this same life-altering condition (1). 

Heavy menstrual bleeding is one of the chief problems that women report to their doctors, according to the U.S. Centers for Disease Control and Prevention (CDC) (1). About one in five women experience heavy menstrual bleeding (1), but only one-third of those seek treatment for it (2). 

A heavy flow can either be normal for your body or it may be a sign of a significant health problem. If your periods are draining you of energy, keep you home from work, disrupt your life — that is not normal and you should speak to your doctor. 

Here we answer your most pressing questions about heavy menstrual bleeding, including why it happens and how charting may help get to the bottom of what’s causing it.

What qualifies a period as heavy menstrual bleeding?

Typical menstrual bleeding lasts about 4-5 days, during which you lose about 2-3 tablespoons of blood (1). With a heavy menstrual period — what doctors called menorrhagia — you may lose twice as much blood and bleed longer (1). Both the American College of Obstetricians and Gynecologists (ACOG) and the CDC define menorrhagia as menstrual bleeding lasting more than seven days (1, 2). 

How do I know if my menstrual bleeding is heavy?

A heavy flow is a tell-tale sign. The CDC defines heavy bleeding as a flow requiring you to change your pad or tampon after less than 2 hours (1). Meanwhile, ACOG describes it as soaking through a tampon or pad every hour for several hours in a row (2). 

Other potential signs of heavy menstrual bleeding include (2):

• Needing to double-up on pads to manage your flow
• Changing your pad or tampon overnight 
• Having a flow that keeps you from normal activities
• Feeling a constant pain in your lower abdomen during your period
• Feeling sapped of energy, tired, or short of breath

With any of these signs, it’s a good idea to contact your doctor, who can get to the bottom of whether an underlying condition may be to blame for your heavy flow.

What causes heavy menstrual bleeding?

The short answer is a lot of things. Frustratingly, doctors sometimes don’t know what’s behind a super heavy flow, however, here are the most common reasons for heavy bleeding (2, 3):

• Hormonal imbalance: This includes polycystic ovary syndrome (PCOS), insulin resistance, or thyroid problems
• Endometriosis: An overgrowth of the endometrium, which is your uterine lining
• Ovulation disorders: For example, if you don’t ovulate regularly, your endometrium may become too thick
• Adenomyosis: An often painful condition where your endometrium breaks through your uterine wall 
• Intrauterine device (IUD): Copper IUDs in particular are linked to long, heavy, painful periods (4)
• Uterine fibroids or polyps: Noncancerous growths on your uterus
• Miscarriage or ectopic pregnancy: For example, a miscarriage is likely to cause a single, late, heavy period
• Pelvic inflammatory disease: An infection usually caused by a sexually transmitted disease
• Bleeding disorders: Conditions that interfere with your blood’s ability to clot properly
• Medications: Hormonal medications, such as estrogen and progestins, anti-inflammatories, and even aspirin may cause prolonged bleeding
• Endometrial cancer:his usually only occurs in women who are past menopause.

How does my doctor diagnose heavy menstrual bleeding?

Expect your provider to ask a lot of questions about your period. They may even ask you to fill out a chart (like this one) describing your flow and the number of menstrual products you use (1). 

If you’re tracking your periods — and therefore intimately acquainted with your cycle — that will be hugely beneficial during this discussion with your provider. The more information you can share, the better. Because heavy bleeding can be caused by a host of conditions, providing detailed data about your cycle helps your provider understand what’s going on with you.

Your provider also will likely conduct a pelvic exam and may recommend tests to look for signs of one of the underlying conditions we mentioned (1). You may need a blood test, Pap smear, ultrasound, or they may suggest taking a small sample of your endometrium for analysis (1).

After the results of your test (or tests) come back, you sometimes need more powerful tests. These tests may include a sonohysterogram, which is a type of ultrasound exam that uses saline fluid, or a hysteroscopy, which uses a slim viewing device to see inside your uterus (1).

Once your provider diagnoses you, they recommend a treatment plan for your specific condition. 

Next week, check back for information on current treatments for heavy menstrual bleeding.

Photo by Kinga Cichewicz on Unsplash

References:

1. https://www.cdc.gov/ncbddd/blooddisorders/women/menorrhagia.html
2. https://www.acog.org/Patients/FAQs/Heavy-Menstrual-Bleeding?IsMobileSet=false
3. https://www.mayoclinic.org/diseases-conditions/menorrhagia/symptoms-causes/syc-20352829
4. https://www.uptodate.com/contents/intrauterine-contraception-background-and-device-types?search=copper%20iud&source=search_result&selectedTitle=1~50&usage_type=default&display_rank=1#H1699895137