Excessive Menstrual Bleeding? Possible Causes Of Heavy Periods

A common disorder among people who menstruate is heavy menstrual bleeding (formerly known as menorrhagia).

The term refers to bleeding that lasts for more than seven days and involves more blood flow than usual during menstruation. 

What is heavy menstrual bleeding (menorrhagia)?

The term heavy menstrual bleeding (formerly known as menorrhagia) refers to extremely heavy or prolonged periods. It means that you lose more blood than is normal during menstruation or that your period lasts longer than seven days. You may have to change your tampon or pad every hour for several hours back-to-back if you bleed a lot. Blood clots up to the size of a quarter may be passed.

Menstrual bleeding that interferes with your daily life is never normal. 

How common are heavy periods?

Heavy period bleeding is common, affecting anywhere from 27% to 54% of people who menstruate.

Is it serious?

When you lose so much blood during menstruation that you show signs of anemia, heavy bleeding can be serious. Anemia occurs when your body does not have enough iron. Without treatment, anemia can be life-threatening.

Moreover, some conditions that cause heavy period bleeding, such as cancer, require early medical treatment. 

What are the signs and symptoms of heavy menstrual bleeding?

Signs of heavy menstrual bleeding include:

• Abdominal pain.

• Periods lasting longer than seven days.

• Passing blood clots that are the size of a quarter or bigger. The blood may appear red, pink, brown, or even rust-like.

• Bleeding through 1 or more tampons or pads each hour for more than two consecutive hours.

• Losing more than 80 milliliters of blood during your period instead of what is typical, 35-40 milliliters.

• Anemia symptoms, like feeling exhausted, tired or short of breath.

With anemia, you may also notice signs of a condition called pica. Pica symptoms include hair loss, pale skin, and the urge to eat non-food items (paper, hair, dirt, etc.). See your health provider if you have these symptoms.

How do you know if you have heavy menstrual bleeding?

Heavy menstrual bleeding interferes with your quality of life. Many people with heavy periods assume that periods are supposed to be inconvenient and uncomfortable. They may have watched people in their families live with heavy periods without seeking care and followed their example. But periods should never cause you to restrict activities or accept inconvenience.

During your period, you should be able to:

• Wear a standard pad or tampon every three to four hours without changing it.

• Wear a single menstrual product without having to double-up (wearing two pads or two tampons at the same time) at any point.

• Leave your home without having to pack extra bags of pads or clothing changes.

• Live your life as usual, without missing work, avoiding going out in public, or skipping activities you enjoy.

If your periods are disrupting your life, it's time to see your provider.

How long does heavy menstrual bleeding last?

Heavy menstrual bleeding is a period that lasts longer than seven days. How long you bleed depends on what's causing your bleeding.

What causes heavy menstrual bleeding?

The causes of heavy menstrual bleeding can range from hormone-related problems to medical conditions and even stress.

Hormone imbalances

Your body produces hormones like estrogen and progesterone to regulate your menstrual cycle, including how heavy your periods are. It is possible to experience heavy period bleeding if you have a condition that causes your hormones to become imbalanced. Causes include:

• Anovulation.

• Thyroid disease.

• Polycystic ovary syndrome (PCOS).

Weighing more than your ideal body weight can interfere with your body's hormone production and lead to heavy menstrual bleeding, too.

Non-cancerous growths in your uterus

Benign growths in your uterus and conditions that cause cells in your uterus to grow improperly can cause heavy menstrual bleeding, too. Causes include:

• Polyps.

• Fibroids.

• Adenomyosis.

Cancerous growths in your uterus

Heavy menstrual bleeding can be caused by conditions that increase your risk of getting cancer, such as endometrial hyperplasia and cancers of the reproductive system. These include:

• Uterine cancer.

• Cervical cancer.

Infection

Infections, including sexually transmitted infections (STIs) can cause heavy bleeding. These include:

• Trichomoniasis.

• Gonorrhea.

• Chlamydia.

• Chronic endometritis.

Pregnancy complications

Heavy bleeding can be a warning sign of pregnancy complications, such as:

• Miscarriage.

• Ectopic pregnancy.

• C-Section niche. High numbers of cesarean sections can lead to a scar that creates a pocket in your uterus. That pocket can collect blood, which you can later bleed.

Other medical conditions

Heavy menstrual bleeding is a symptom associated with various conditions, including bleeding disorders and non-bleeding disorders. Some common medical conditions that can lead to heavy bleeding are:

• Von Willebrand disease.

• Liver disease.

• Kidney disease.

• Pelvic inflammatory disease (PID).

• Leukemia or platelet disorders.

Medications

Certain medicines can cause heavy menstrual bleeding, too. These include:

• Blood thinners and aspirin.

• Hormone replacement therapy.

• Tamoxifen (breast cancer drug).

• Intrauterine devices (IUDs).

• Birth control pills and injectables.

Failing to remove contraceptive devices when needed can also cause abnormal uterine bleeding.

How is heavy period bleeding prevented?

Heavy period bleeding cannot be prevented in all cases. Your healthcare provider can help you manage your bleeding so it doesn't interfere with your quality of life by diagnosing and treating you.

What is the prognosis for living with heavy menstrual bleeding?

Left untreated, heavy periods can interfere with your life. In addition, heavy menstrual bleeding can cause anemia and leave you feeling tired and weak. Other health problems can also arise if you don't get help. With proper treatment and assistance from your provider, you can manage heavy periods without compromising your well-being.

When do you call your healthcare provider if you suspect heavy period bleeding?

You should call your provider if you're experiencing the symptoms of heavy menstrual bleeding or anemia, or if your period bleeding has become abnormal. Tracking your periods using a calendar or app can help you identify if your periods are heavier and longer-lasting than usual. Share these notes with your provider.

You should also schedule an appointment if you notice that you're having to double-up on menstrual products or if you're skipping activities you enjoy because of heavy bleeding.

Can heavy menstrual bleeding be life-threatening?

Heavy periods aren’t usually life-threatening, but they can be if you lose too much blood. Bleeding through two or more tampons or pads each hour for two hours in a row is a sign that you should see your provider or seek emergency care immediately.