Learn about the causes and treatment of heavy menstrual periods.
Some women have menstrual bleeding that is heavy or lasts for more than a few days. This condition used to be called menorrhagia. Heavy menstrual bleeding is a common concern. But most women don't have enough blood loss for it to be called heavy menstrual bleeding.
Some women have menstrual bleeding between periods, or earlier or later in their cycles than expected. This type of bleeding is called abnormal uterine bleeding or irregular menstrual bleeding.
With heavy menstrual bleeding, blood flow and cramping make it harder to do your usual activities. If you dread your period because you have heavy menstrual bleeding, talk with your doctor. There are many treatments that can help.
Symptoms of heavy menstrual bleeding may include:
Seek medical help before your next scheduled exam if you have:
In some cases, the reason for heavy menstrual bleeding is unknown. But a number of conditions may cause heavy menstrual bleeding. They include:
Hormones being out of balance. In a typical menstrual cycle, there's a balance between the hormones estrogen and progesterone. This controls the buildup of the lining of the uterus. The lining of the uterus also is known as the endometrium. This lining is shed during a menstrual period. When hormones are out of balance, the lining becomes too thick and sheds by way of heavy menstrual bleeding or unexpected bleeding between periods.
A number of conditions can cause hormone imbalances. These include obesity, insulin resistance, thyroid problems and polycystic ovary syndrome, which also is called PCOS.
There are three major types of uterine fibroids. Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus. Some submucosal or subserosal fibroids may be pedunculated. This means they hang from a stalk inside or outside the uterus.
Risk factors vary with age and the medical conditions you have. Usually, the release of an egg from the ovaries signals the body to make progesterone. Progesterone is the hormone most responsible for keeping periods regular. If no egg is released, the body does not make enough progesterone. This can result in heavy menstrual bleeding or unexpected bleeding between periods.
In teenagers, an irregular period or heavy menstrual bleeding often happens when an egg is not released during a monthly cycle. Teenagers are most likely to have cycles without an egg release during the first year after they have their first period.
In older women of reproductive age, heavy menstrual bleeding is often caused by problems with the uterus. These include fibroids, polyps and adenomyosis. But other problems also could cause heavy menstrual bleeding. Examples include cancer of the uterus, bleeding disorders, side effects of medicines, and liver or kidney disease.
Menstrual bleeding that is too heavy or lasts too long can lead to other medical conditions. These include:
Anemia. Heavy menstrual bleeding can cause anemia related to blood loss. Anemia is a condition in which the body lacks enough red blood cells to carry oxygen to tissues. The number of red blood cells is measured by hemoglobin. Hemoglobin is a protein in red blood cells that carries oxygen to tissues throughout the body.
Iron deficiency anemia occurs as the body tries to make up for lost red blood cells. The body uses iron stores to make more hemoglobin so that enough oxygen can be carried to tissues. Heavy menstrual bleeding may make iron levels too low. This may result in iron deficiency anemia.
Symptoms include headaches and feeling tired. Although diet plays a role in iron deficiency anemia, the problem is made worse by heavy menstrual periods.
A member of your health care team will likely ask about your medical history and menstrual cycles. You may be asked to keep a diary to track days with and without bleeding. Record information such as how heavy your flow was and how many sanitary pads or tampons you needed to control it.
After doing a physical exam, your doctor or other member of your care team may recommend certain tests or procedures. They may include:
Results of these initial tests may lead to more testing, including:
Your doctor can make a diagnosis of heavy menstrual bleeding or abnormal uterine bleeding only after it's known that something else isn't causing your condition. These causes may include menstrual disorders, medical conditions or medicines.
During hysterosonography (his-tur-o-suh-NOG-ruh-fee), you have a thin, flexible tube called a catheter placed in the uterus. Salt water, also called saline, is injected through the flexible tube into the hollow part of the uterus. An ultrasound probe transmits images of the inside of the uterus to a nearby monitor.
Treatment for heavy menstrual bleeding is based on a number of factors. These include:
Medicines for heavy menstrual bleeding may include:
If you have heavy menstrual bleeding from taking hormone medicine, you may need to stop or change your medicine.
If you have anemia due to heavy menstrual bleeding, you may need to take iron supplements. If your iron levels are low but you're not yet anemic, you may be started on iron supplements instead of waiting until you become anemic.
You may need surgery for heavy menstrual bleeding if medicines do not help. Treatment options include:
Endometrial ablation. This procedure involves destroying the lining of the uterus. The process of destroying tissue also is known as ablation. The surgeon uses a laser, radio waves or heat applied to the lining of the uterus to destroy the tissue.
After endometrial ablation, you may have much lighter periods. Pregnancy after endometrial ablation isn't likely but is possible and could be dangerous. Using reliable or permanent birth control until menopause is recommended.
Many of these surgical procedures are done on an outpatient basis. You may need a general anesthetic but it's likely that you can go home on the same day. With an abdominal myomectomy or a hysterectomy, you may need a brief hospital stay.
Sometimes heavy menstrual bleeding is a sign of another condition, such as thyroid disease. In those cases, treating the condition usually results in lighter periods.
You may start by seeing your primary care doctor or other health care professional. Or you may be referred immediately to a specialist called an obstetrician/gynecologist.
Here's some information to help you get ready for your appointment.
When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of:
Take a family member or friend along, if possible, to help you remember the information you're given.
For heavy menstrual bleeding, some basic questions to ask your care team include:
Don't hesitate to ask any other questions as they occur to you during your appointment.
You may be asked certain questions during your appointment, such as:
Avoid doing anything that seems to worsen your symptoms.