What is heavy menstrual bleeding?
Heavy menstrual bleeding (also called menorrhagia) is when menstrual periods are unusually heavy or last more than 7 days. In a normal menstrual period, most people lose about 2–3 tablespoons (30–40 mL) of blood over 3–7 days. Teens and women with heavy menstrual bleeding can lose twice that amount.
Heavy bleeding can interfere with daily life and emotional health. Loss of blood during heavy periods can also cause health problems such as iron-deficiency anemia. Anemia can make you feel tired, dizzy, weak, and short of breath.
Heavy menstrual bleeding can be one of the first signs of a bleeding disorder. It is important to talk to your health care provider about your symptoms and treatment options.
After puberty, females start having menstrual cycles, a monthly hormonal cycle from the start of one period to the start of the next. The average menstrual cycle is about 28 days, with a normal range of 21–35 days.
During the menstrual cycle, the lining of the uterus thickens to prepare the body for a pregnancy. The ovaries release an egg, which travels through the fallopian tube to the uterus. This is called ovulation. If a sperm fertilizes an egg, pregnancy can occur.
If the egg is not fertilized, your body will get rid of the lining of your uterus because it is not needed. Your uterus sheds its lining (blood and tissue) through the cervix and out of the vagina. This is your menstrual period.
If you are pregnant, hormones pause the monthly menstrual cycle so that you do not have periods.
Symptoms of heavy menstrual bleeding
Signs and symptoms of heavy menstrual bleeding may include:
- Needing to change your pad or tampon every 2 hours or more often
- Periods that last longer than 7 days
- Passing blood clots larger than the size of a quarter (about 1 inch)
- Needing to change your pad or tampon during the night
- Bleeding through your clothes or bedding
- Needing to use double protection (a pad and a tampon)
- Feeling tired, weak, or short of breath
Causes of heavy menstrual bleeding
Heavy periods are common and affect about 1 in 5 women of reproductive age. They can be caused by different factors. These include:
- Having low platelets
- Bleeding disorders that reduce the ability of blood to clot
- Certain medicines, such as aspirin or blood thinners
- Hormone imbalances
- Irregular ovulation or missed periods, which can cause the uterine lining to thicken
- Problems with your uterus, such as fibroids, polyps, or cancer
Other causes of heavy periods may include stress, obesity, PCOS (polycystic ovary syndrome), thyroid conditions, endometriosis, or pelvic inflammatory disease (PID). Heavy menstrual bleeding may be more common when you first start menstruating or near menopause.
Heavy menstrual bleeding and bleeding disorders
In a bleeding disorder, blood does not clot properly. This can cause bleeding to be heavy or hard to stop. Heavy menstrual bleeding can be a symptom of certain bleeding disorders such as von Willebrand disease, thrombocytopenia, platelet disorders, and hemophilia.
Other signs and symptoms of a bleeding disorder include:
- Nosebleeds that are hard to stop
- Unexplained or unusual bruising or bleeding
- Bleeding gums
- Heavy bleeding after a dental or medical procedure
- Blood in the urine (pee) or stool (poop)
- Purpura: bruising or purplish spots on the skin, lips, or inside the mouth
- Petechiae: small red or purple "pinpoint" dots on the skin that may look like a rash
Talk to your health care provider if you have symptoms of a bleeding disorder.
Your health care provider will do a medical history and physical exam, including a pelvic exam. They may ask about any changes in bleeding or bruising, recent illnesses, medicines, and family history of bleeding disorders.
Your provider may ask you questions about your periods and how they affect your daily life. Questions your doctor may ask include:
- When did you get your first period?
- How often do you get your period?
- When was your last period?
- How long do your periods usually last?
- How heavy is your period?
- How often do you have to change your pad or tampon on your heaviest day?
- Does your period affect your daily life (school, work, sports, or social activities)?
- Do you have other symptoms, such as cramping, nausea, blood clots, dizziness, or bleeding between periods?
Your care team may do tests to understand the cause of heavy menstrual bleeding. Tests may include:
- Blood tests to measure blood cell counts, hormones, and iron levels to detect underlying causes such as thyroid problems or bleeding disorder
- Pelvic ultrasound to look at your uterus, ovaries, and vagina to check for possible growths
- Pap test (Pap smear) to check for abnormal cells in the cervix (lower part of the uterus)
- Biopsy to examine tissue from the inside of your uterus
- Diagnostic hysteroscopy to look inside the uterus
Depending on the results of these tests, more testing may be needed.
Treatment of heavy menstrual bleeding
Treatment for heavy menstrual bleeding will depend on the cause of bleeding and how serious it is. It will also depend on your health, age, symptoms, and your preferences.
Medicines
Treatment of heavy periods usually starts with medicine or hormonal therapies. Medicines may include:
- Hormonal therapies, such as hormonal birth control methods or progestin
- Medicines that help blood to clot or prevent clots from breaking down, such as desmopressin, tranexamic acid, or aminocaproic acid
- Iron supplements
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen
Surgery
In some cases, surgery may be needed. If needed, surgical options may include:
- Dilation and curettage (D&C): a procedure to remove the top layer of the uterine lining
- Operative hysteroscopy: a procedure that uses a small tool called a hysteroscope, along with other surgical instruments, to remove polyps, fibroids, or the uterine lining from the uterus
- Endometrial ablation or resection: a procedure that removes part or all of the uterine lining. This procedure makes it impossible to become pregnant in the future.
- Hysterectomy: a major surgery to remove the uterus. After a hysterectomy, you will no longer have periods or be able to get pregnant.
The prognosis for heavy menstrual bleeding depends on the underlying cause. Talk to your care team about treatment options and which is the best choice for you. There are ways to help manage heavy periods to improve your overall health and quality of life.
Tips for coping with heavy menstrual bleeding
Talk honestly with your health care provider.
- Many people do not get help for heavy menstrual bleeding because they are embarrassed to talk about it. Be honest and open about your symptoms and any questions you may have.
- Treatments can depend on your wants and needs. Consider whether you are more concerned about pain, having regular periods, fertility, or controlling bleeding. Tell your care team what is most important to you.
Keep track of your periods.
- Track your periods each month. Note the start date, end date, and how heavy it was. You can count how many pads or tampons you use each day to measure the blood flow.
- Note any symptoms you have and factors that may influence them, such as medicines, stress, or illness. You can keep these notes wherever it is best for you. That may be a notebook, calendar, or an app on your phone.
Make a plan.
- Keep a bag with you that includes extra underwear, clothes, a sweatshirt to wrap around your waist, and period supplies.
- Talk to a friend about what’s going on and ask them to let you know if they see you leaking.
- Talk to your school about making a 504 plan so that you can use the restroom and go to the school nurse when needed.
Choose menstrual products that are right for you.
- There are different types of menstrual products that you might consider during your period. These include:
- Pads: Soft liners that stick to your underwear and soak up blood. They come in different sizes and thicknesses.
- Tampons: Small, cylindrical hygiene products you put inside your vagina to absorb blood.
- Menstrual cups: Flexible cups made of silicone or rubber that go inside your vagina and collect blood instead of soaking it up. Menstrual cups can hold more blood than a super tampon.
- Menstrual discs: Similar to cups but sit higher in the vagina and can be worn during sex.
- Period underwear: Special reusable underwear that absorbs blood without needing pads or tampons. You might wear period underwear along with other products on heavy days or while sleeping.
- At night, you may want to place a towel underneath you while sleeping. Period underwear may also help with leaks.
Take care of your health.
- Heavy menstrual bleeding can lead to iron deficiency anemia, which causes fatigue and other problems. Iron-rich foods like spinach, red meat, beans, and lentils can help replenish iron lost during heavy periods. Your care team may also prescribe iron supplements. Be sure to follow your care team’s instructions when taking iron.
- Find ways to manage pain. Talk to your care team about what might work best for you. Do not take aspirin as it can make bleeding worse. Methods for managing pain may include taking ibuprofen, using a heating pad, taking a warm bath, stretching, and exercising.
- While on your period, be sure to exercise, eat healthy, drink plenty of water, limit salt and caffeine, and get enough sleep. This can help you feel better and manage symptoms like fatigue, bloating, and discomfort.
When to call your care team
Call your care team or go to the emergency room as soon as possible if you:
- Soak through a pad or tampon every hour for several hours
- Use 2 pads or tampons every hour for 2 hours straight
- Pass a blood clot that is larger than the size of a quarter
- Have a period that lasts for more than 7 days
- Feel dizzy, weak, extremely tired, or short of breath
- Have extreme pain with your period
Seek medical care if you have bleeding and are pregnant or think you may be pregnant. Bleeding during pregnancy can be an emergency.
Questions to ask your care team
