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.
Imaging Histology And Microbiology
- Ultrasound pelvis
- Transvaginal US is most clinically useful for assessing the endometrium and ovaries.
- It should be considered if the uterus or a pelvic mass is palpable on examination, or if pharmacological treatment has failed.
Abnormally Short Or Long Periods
Normal periods can last anywhere from two to seven days. Short periods may be nothing to worry about, especially if theyre typical for you. Using hormonal birth control can also shorten your cycle. Going into menopause can disrupt your normal cycles as well. But if your periods suddenly get much shorter, check in with your doctor.
Some of the same factors that cause heavy bleeding can make your periods longer than usual. These include a hormone imbalance, fibroids, or polyps.
Cramps are a normal part of periods. Theyre caused by uterine contractions that push out your uterine lining. Cramps typically start a day or two before your flow begins, and last for two to four days.
For some women, cramps are mild and not bothersome. Others have more severe cramps, called dysmenorrhea.
Other possible causes of painful cramps include:
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What Are The Risk Factors For A Miscarriage
A risk factor is a trait or behavior that increases a persons chance of developing a disease or condition. Risk factors for miscarriage include:
- Your age: Studies show that the risk of miscarriage is 12% to 15% for people in their 20s and rises to about 25% for people by age 40. Most age-related miscarriages happen because of a chromosomal abnormality .
- Previous miscarriage: You have a 25% chance of having another miscarriage if youve already had one.
- Health conditions: Certain health conditions like unmanaged diabetes, infections or issues with your uterus or cervix increase your chance of miscarriage.
Talk to your pregnancy care provider about the risk factors for miscarriage. They can discuss your risk after theyve reviewed your medical history.
Extreme Tiredness May Be An Underlying Medical Condition
Heavy menstrual bleeding often causes women to feel tired, commonly known as period fatigue. This is normal due to the decrease in oestrogen levels, which occurs around this point in your menstrual cycle. Your energy levels will usually return to normal within a few days as your hormone levels begin to increase again. However, for some women, period fatigue and mood swings may last longer and be more extreme. Some women may experience pre-menstrual symptoms and find themselves completely sluggish and unable to properly carry out routine activities, signifying something more severe.
This should be investigated as there could, in fact, be a medical reason or underlining gynaecological conditions as to why your energy levels are low and you feel so fatigued during your period. You may generally be a person whose periods cause them to feel more tired than others, or you might have an underlying medical issue like anaemia or an underactive thyroid. The important point to make is that you should never ignore extreme menstrual fatigue.
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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 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 Is Heavy Menstrual Bleeding Treated
Treatment depends on what’s causing your bleeding, how severe your bleeding is, your health, age and medical history. Also, treatment depends on your response to certain medicines and your preferences. For instance, you may not want to have a period at all, or you may want to reduce your bleeding. In addition, your plans to get pregnant will affect your treatment options.
Talk with your provider about your health concerns and your goals for treatment.
Medications used to treat heavy menstrual bleeding
- Iron supplements improve your iron stores.
- Nonsteroidal Anti-inflammatory Drugs like Ibuprofen® or Aspirin® can ease your cramps and reduce your bleeding.
- Birth control may help make your periods more regular and lighten your blood flow.
- Hormone therapy can help balance the amount of estrogen and progesterone in your body so that your menstrual flow isn’t as heavy. HT is often recommended for heavy menstrual bleeding associated with perimenopause but comes with risks that you should discuss with your provider.
- Gonadotropin-releasing hormone agonists can temporarily stop or reduce bleeding by preventing ovulation.
- Gonadotropin-releasing hormone antagonists can manage heavy period bleeding related to fibroids.
- Desmopressin nasal spray can stop bleeding associated with von Willebrand disease by helping your blood clot.
- Antifibrinolytic medicines, like tranexamic acid, prevent clots from breaking down and causing excessive bleeding.
Procedures used to treat heavy period bleeding
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Expert Management For Painful Periods And Heavy Bleeding
For most women, menstrual cycles occur about every 28 days, and periods last four to seven days. Abnormal menstruation includes problems such as heavy bleeding, known as menorrhagia, irregular menstrual bleeding, and pain during periods, known as dysmenorrhea.
UT Southwestern gynecologic surgeons, specialists, and their teams are nationally recognized for their expertise in womens health care. We participate in research to improve diagnosis, management, and treatment for heavy, irregular, painful periods. Our specialists are also faculty members, dedicated to educating future womens health doctors and other care providers.
How To Treat Menorrhagia
The treatment for menorrhagia depends on the cause and desired outcome. Often, menorrhagia is managed with medications. However, sometimes procedures or surgeries are needed.
Medication treatments for menorrhagia include:
- Non-steroidal anti-inflammatory drugs, such as Advil and Aleve , may help reduce pain from cramping and lower inflammation.
- Lysteda helps reduce menstrual blood loss.
- Oral hormonal contraceptives may help correct hormonal imbalances and regulate periods.
- Oral progesterone may help correct a hormonal imbalance and improve heavy bleeding symptoms.
- Hormonal IUDs, such as Mirena or Liletta, help thin the uterine lining and decrease blood flow.
If the heavy bleeding began after starting a new medication, your healthcare provider might be able to recommend a different type of medication or dose. Changing the medication may stop the menorrhagia completely.
In some cases, medications alone arent enough to treat menorrhagia. Your healthcare provider may recommend a procedure, such as:
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Where Should I Keep My Medication
Keep out of the reach of children.
Store at room temperature between 15 and 30 degrees C . Throw away any unused medicine after the expiration date.
NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.
How Can I Overcome Fatigue From Endometriosis
Eating a healthful diet, taking supplements such as iron or vitamin D, exercising, and keeping a consistent sleep schedule may help reduce fatigue in people living with endometriosis.
In addition, talking with friends, meeting people through social networks or online forums, or seeing a therapist can prevent feelings of isolation, reduce the risk of developing a mood disorder, and provide valuable tips and advice that can help a person cope.
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What Are The Symptoms Of Menorrhagia
The classic symptoms of menorrhagia are: having a period that lasts more than a week and soaking through a tampon or sanitary pad every hour for several consecutive hours.
Other symptoms may include the following:
- Passing blood clots larger than a quarter
- Needing to use double sanitary protection
- Waking up to change sanitary protection during the night Exhibiting symptoms of anemia
What Tests Will Be Done To Diagnose Anovulation
Tests for diagnosing anovulation depend on what your healthcare provider suspects are causing your anovulation. Tests that can help diagnose anovulation, include:
- Blood progesterone levels.
- Blood prolactin levels.
- An ultrasound exam of your pelvic organs.
Many of the hormone imbalances that cause anovulation have other symptoms, so your provider may have you undergo other tests if youre experiencing symptoms of a certain hormone imbalance condition.
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Symptoms Of Painful Periods And Heavy Bleeding
Signs and symptoms of heavy menstrual bleeding include:
- Bleeding for more than seven days
- Bleeding that soaks through one or more tampons or pads every hour for several hours in a row
- Need to use multiple pads to control menstrual flow
- Need to change pads or tampons during the night
- Menstrual flow with blood clots larger than a quarter
- Flooding of clothing and bedsheets with menstrual bleeding
- Symptoms of anemia, such as fatigue and shortness of breath
Symptoms of menstrual pain include:
- Lower back pain
- Pain that starts a few days before the period, worsens during the period, and lasts two to three days after the period ends
- Throbbing or cramping pain in the lower abdomen that can be intense
- Lower back pain during menses
Patients should see their doctors if:
- Their periods stop for more than 60 days
- Their periods become erratic
- They have any vaginal bleeding after menopause
- They suddenly get a fever and feel sick after using tampons
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.
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What Are The Symptoms Of Heavy Or Irregular Periods
The length of the menstrual cycle and amount of blood flow is unique to each woman. However, most women have a cycle that ranges from 24 to 34 days.
Blood flow averages about four or five days, with a blood loss of about 40 cc . Its important to remember that these are just averages. Your normal may fall outside of these ranges. A blood loss of 80 cc or more is considered an abnormally heavy flow.
Signs that your menstrual flow may be abnormally heavy include:
- soaking through more than one tampon or sanitary pad in an hour for several hours at a time
- waking up during the night because you need to change protection
- passing large blood clots in your menstrual flow
- experiencing a menstrual flow that lasts more than a week
Also, an abnormally heavy flow can cause you to experience the following symptoms, which may be an indication of anemia:
- shortness of breath
While every womans cycle is different, irregularities such as bleeding mid-cycle or bleeding after intercourse are abnormal symptoms.
You should see your gynecologist regularly for a checkup. However, make an appointment right away if you have bleeding or spotting in the following circumstances:
- between periods
Keep track of your menstrual cycles, including how long your blood flow lasts, and how many tampons or sanitary pads you use during each cycle. This information will be helpful at your gynecological appointment.
Avoid products that contain aspirin because they may increase bleeding.
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.
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What Causes Menorrhagia
There are a number of different causes of heavy menstrual bleedingincluding benign growths, like fibroids, or malignant growths, like cancer of the uterus or cervix. Hormone changes or blood clotting disorders can cause menorrhagia too.
Other less common causes of heavy menstrual bleeding include endometriosis and having an intrauterine device like the ParaGard, which may cause excessive bleeding, especially during your first year of use.
But the list does not stop there. That’s why it’s important to see a healthcare provider for a proper diagnosis and evaluation.
When Is A Period Heavy
Throughout your menstrual cycle, the degree of menstrual bleeding differs from woman to woman a period can be considered heavy when the following symptoms occur:
- At least one sanitary towel or tampon is soaked through each hour
- A pad and a tampon is used at the same time
- Waking up in the night to change sanitary product
- Bleeding for more than a week
- Large blood clots
- Normal day-to-day activities are affected
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Is Heavy Menstrual Bleeding Serious
Heavy menstrual bleeding can be serious if you lose so much blood that you show signs of anemia. Anemia is a condition arising from having too little iron in your body. Anemia can be life-threatening without treatment.
Also, some of the conditions that can cause heavy period bleeding, like cancer, require early medical intervention. Speak with your healthcare provider to discuss any risks related to your period bleeding.
What Causes Period Fatigue
It’s hard to pinpoint what might be contributing to your period fatigue because many factors may be at fault.
Hormonal changes. During menstruation, your body experiences changes in hormone levels that can leave you feeling tired, Mandal says. During a typical 28-day cycle, estrogen rises for two weeks, then drops sharply after ovulation, staying low for the weeks before and during your period.
“Estrogen levels peak and then decrease quickly before the onset of the menstrual cycle, which can cause fatigue and sluggishness,” Mandal says.
Some women experience a corresponding drop in the neurotransmitter serotonin as their estrogen levels fall. Having low serotonin levels has been linked to depression and fatigue, so a drop in serotonin levels could help explain period fatigue, Mandal says.
Blood and associative iron loss. Additionally, the blood loss during your period can contribute to fatigue due to a loss of iron. If you have heavy bleeding or you’re already prone to lower iron levels, this may result in temporary anemia, a condition caused by iron deficiency that comes with symptoms including fatigue. A heavy period is defined as a blood loss of over 80 cc per month.
Dehydration and stress. Lifestyle factors, including dehydration and stress, can also contribute to period fatigue, Mandal says. While these are general causes of fatigue not specific to your period staying well hydrated and reducing stress during your period could help combat fatigue, Mandal says.
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What Are The Signs And Symptoms Of Anovulation
Being aware of the general signs of ovulation and keeping track of your menstrual cycles can help alert you to signs and symptoms of anovulation. Its important to remember that having a period doesnt necessarily mean youve ovulated. Signs and symptoms of anovulation can include:
- Having irregular periods: If the length of time in between your periods keeps changing, its considered an irregular period. The average menstrual cycle is 28 days, but it can be a couple of days shorter or longer than that.
- Having very heavy or light periods: A heavy period is defined by losing over 16 teaspoons of blood within your period and/or having a period that lasts longer than seven days. Blood loss of fewer than four teaspoons throughout your period is considered a light period.
- Having a lack of periods : Missing one or more periods without being pregnant could be a sign of anovulation.
- Having a lack of cervical mucus: Right before and during ovulation, you usually have the most vaginal discharge called cervical mucus. It usually looks like raw egg whites. If you don’t have this discharge, you may be experiencing anovulation.
- Having an irregular basal body temperature: Your basal body temperature is your temperature when you’re fully at rest. Its usually taken after you wake up and before youve done any type of physical movement or activity. Ovulation can cause a slight increase in your basal body temperature.