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Heavy Menstrual Periods
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This topic covers heavy menstrual bleeding, including information about symptoms, tests, and home treatment. For more information, see the topics Normal Menstrual Cycle, Abnormal Uterine Bleeding, Uterine Fibroids, and Endometriosis.
What are heavy menstrual periods?
If you bleed a lot during your menstrual cycle, you're not alone. Many women do. When you have heavy menstrual periods (also called menorrhagia), you may:
- Pass large blood clots and soak through your usual pads or tampons.
- Bleed for more than 7 days. (A normal period usually lasts 4 to 6 days.)
- Have severe menstrual cramps.
Heavy periods can be messy and unpleasant, and they may disrupt your life. But in most cases, they aren't a sign of a serious problem.
Still, it's a good idea to see your doctor. A doctor can suggest treatments to ease your symptoms and make sure that you don't have a more serious condition.
What causes heavy periods?
A number of things can cause heavy periods. These include:
- A change in hormones. Normally one of your ovaries releases an egg during your menstrual cycle. This is called ovulation. If you don't ovulate, your hormone levels can get out of balance. This can affect the lining in your uterus and may cause heavy bleeding.
- An irritation in the uterus. Certain things can cause this, such as using a copper IUD.
- A growth in the uterus, such as a polyp or fibroid.
- Adenomyosis. This condition occurs when the cells that normally line the uterus grow into the wall of the uterus.
- Some bleeding disorders that prevent blood from clotting properly.
- Certain medicines, such as anticoagulants.
Sometimes a cause can't be found.
When are heavy periods a cause for concern?
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 and weak. Call your doctor if you think you have anemia.
In rare cases, heavy periods may be a sign of a serious problem, such as an infection or cancer.
Call your doctor now or seek immediate medical care if:
- You pass clots of blood and soak through your usual pads or tampons every hour for 2 or more hours.
- You are dizzy or lightheaded, or you feel like you may faint.
How are heavy periods diagnosed?
Your doctor will ask about your menstrual periods and do a pelvic exam. During the exam, your doctor will check for signs of disease, infection, and abnormal growths.
If needed, your doctor may also do one or more tests to find out what's causing heavy periods. These tests may include:
- A Pap test. This can look for signs of infection and changes in the cells of your cervix.
- Blood tests. These can check for anemia, a bleeding disorder, or other problems.
- A pelvic ultrasound. This test can look for any problems in the pelvic area.
- An endometrial biopsy. It can check for abnormal cell changes in the lining of the uterus (endometrium).
- A hysteroscopy. This can check the lining of your uterus to look for the cause of bleeding, such as fibroids.
How are they treated?
In most cases, heavy menstrual periods can be managed with medicines or hormone treatments. If those treatments don't help, you may need surgery to help control your bleeding.
Your doctor may suggest that you take a nonsteroidal anti-inflammatory drug (NSAID), like ibuprofen (such as Advil or Motrin) or naproxen (such as Aleve). Taking an NSAID can reduce bleeding and pain during your period. But NSAIDs usually don't help as much as hormone treatments.
Hormone treatments that may be prescribed include:
- Birth control pills, patch, or ring. These release two hormones, estrogen and progestin. They prevent pregnancy and also can reduce menstrual bleeding and pain.
- Progestin-only birth control, such as mini-pills, implants, and shots. These types of birth control can reduce bleeding and cramping.
- Progestin pills. These are progestin-only pills that help reduce bleeding but do not prevent pregnancy.
- Hormonal IUD. This is a birth control device that your doctor places inside your uterus. It releases a type of progestin that can reduce bleeding and cramping.
Sometimes doctors prescribe a medicine called tranexamic acid (such as Lysteda). It is not a hormone treatment. It reduces bleeding by helping blood to clot.
You may want to think about surgery if medicines don't help or if you have a growth in your uterus. Your choice will depend partly on whether you want to get pregnant in the future. Surgery options include:
- Hysteroscopy. This procedure is done to diagnose heavy periods. But it can also treat some problems at the same time. For example, fibroids or polyps may be removed during this procedure.
- Endometrial ablation. This procedure destroys the endometrium. This reduces or stops uterine bleeding. But it is not an option if you hope to get pregnant.
- Hysterectomy, a surgery to remove the uterus. This may be an option if heavy bleeding can't be controlled or when the cause of bleeding can't be found and treated. It ends your ability to get pregnant.
What can you do to feel better?
If you have severe cramping during your periods, taking an NSAID such as ibuprofen or naproxen may help. 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 cramping starts.
Heavy periods can make you feel weak and run-down and can lead to anemia. Your doctor may suggest that you take an iron supplement if your iron levels are low. You may be able to prevent anemia if you increase the amount of iron in your diet. Foods rich in iron include red meat, shellfish, eggs, and beans.
Other Works Consulted
- Duckitt K (2015). Menorrhagia. BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/0805/overview.html. Accessed October 15, 2015.
- 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.
Current as of: November 7, 2019
Author: Healthwise Staff
Sarah Marshall MD - Family Medicine
Kathleen Romito MD - Family Medicine
Martin J. Gabica MD - Family Medicine
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