Heavy Periods

Menorrhagia (Heavy Menstrual Bleeding)

Menorrhagia, or heavy menstrual bleeding, is a common disorder among people who menstruate. It refers to bleeding lasting longer than seven days and involves bleeding more than is typical during menstruation. Talk to your provider about treatment options if heavy bleeding during your period affects your quality of life.


You may have menorrhagia if you:

  • Have periods that last longer than seven days.
  • Bleed so much you have to change your pad or tampon every hour for several hours back-to-back.
  • Need to wear multiple pads at a time to prevent leaking blood.
  • Change pads in the middle of the night.
  • Pass blood clots the size of a quarter or larger several times daily.
  • Can’t do your normal activities when you have your period.


Most women don’t enjoy getting their period. But if you have menorrhagia, getting your period is probably miserable. It can interfere with your daily life and make going to work or school hard. Layering up pads and staying home when you have your period can feel debilitating.


Contact your doctor if any of these scenarios apply to you. They can evaluate your symptoms and determine what’s causing you to have heavy periods. Then, they can recommend treatment options to manage heavy blood flow during your period.


How Common is Menorrhagia?

Heavy menstrual bleeding is common, affecting anywhere from 30% to 50% of women who menstruate.


What Are the Signs You're Losing Too Much Blood During Your Period?

Excessive blood loss during your period can be a sign of menorrhagia. Some indicators that you may be losing too much blood include:

  • Needing to change your pad or tampon every hour for several consecutive hours.
  • Layering up on pads to protect against leakage.
  • Passing large blood clots, often the size of a quarter or larger.
  • Experiencing periods that last longer than seven days.
  • Feeling weak, fatigued, or short of breath during your period which could be a sign of anaemia.
  • Having to wear multiple forms of protection (e.g., a pad and tampon) to manage the flow.
  • Waking up at night to change protection due to heavy bleeding.


How Do You Know You Have Menorrhagia?

Heavy menstrual bleeding can significantly impact your daily life, but many people believe that discomfort and inconvenience are just part of having a period. Often, they may have seen family members endure heavy periods without seeking help and assumed it was normal. However, your period should not force you to alter your routine or accept constant inconvenience.


During your period, you should be able to:

  • Use a regular pad or tampon for three to four hours without needing to change it.
  • Rely on one menstrual product without doubling up (e.g., wearing two pads or two tampons simultaneously).
  • Sleep through the night with a single overnight pad.
  • Go out without the need to carry extra pads or changes of clothes.
  • Continue your usual activities, including work, social outings, and hobbies, without disruption.


Risk Factors and Potential Causes of Heavy Periods

There are several potential causes of heavy periods or menorrhagia. These causes can vary, and sometimes, multiple factors can contribute to the condition. Some common causes include:

  • Hormonal imbalances: An imbalance between oestrogen and progesterone, the hormones that regulate the menstrual cycle, can disrupt the normal shedding of the uterine lining, leading to heavy bleeding. Hormonal imbalances can be caused by polycystic ovary syndrome (PCOS), thyroid disorders, or perimenopause.
  • Uterine-related issues:
  • Uterine fibroids: These noncancerous growths in the uterine wall can cause heavy menstrual bleeding.
  • Polyps: Small, benign growths in the uterus lining can lead to heavier periods.
  • Adenomyosis: In this condition, the tissue lining the uterus grows into the muscular wall, causing heavier bleeding and pain.
  • Endometrial hyperplasia: Thickening of the uterine lining can result in heavier periods.
  • Pelvic inflammatory disease (PID): Infections in the reproductive organs, often caused by sexually transmitted infections, can lead to inflammation and heavy bleeding.
  • Blood clotting disorders: Conditions that affect blood clotting, such as von Willebrand disease or certain medications that interfere with clotting, can cause heavy menstrual bleeding.
  • Medications and medical conditions:
  • Certain medications: Blood thinners, anti-inflammatory drugs, or hormonal medications may contribute to increased menstrual bleeding.
  • Underlying medical conditions: Certain conditions, such as liver or kidney disease, bleeding disorders, or hypothyroidism, can be associated with heavy periods.
  • Other factors:
  • Stress: High stress levels can influence hormonal balance and contribute to heavier periods.
  • Obesity: Excess body weight can affect hormone levels and lead to heavier bleeding.


Identifying the underlying cause of heavy periods is important for developing an appropriate treatment plan. If you experience heavy periods, it is recommended to consult with a gynaecologist who can evaluate your symptoms, conduct necessary tests, and provide an accurate diagnosis.


Symptoms of Heavy Periods

  • Prolonged bleeding: Menstrual bleeding lasting more than seven days.
  • Excessive flow: Soaking through sanitary pads or tampons every hour for several hours.
  • Passing large blood clots during menstruation.
  • Needing to use double protection (tampons and pads) or both simultaneously.
  • Fatigue, lightheadedness, or shortness of breath due to anaemia.
  • Severe pelvic pain or cramping during periods.


Diagnosis of Heavy Periods

  • Medical history: Your doctor will ask about your menstrual patterns, bleeding duration, and associated symptoms.
  • Physical examination: A pelvic exam may be conducted to check for any abnormalities in the reproductive organs.
  • Blood tests: Tests to check for anaemia and hormonal imbalances.
  • Imaging tests: Ultrasound or other imaging techniques to identify structural abnormalities like fibroids or polyps.
  • Biopsy: In some cases, a sample of the uterine lining may be taken for further evaluation.


Treatment for Heavy Periods

Heavy periods can be treated through various approaches depending on the underlying cause and individual circumstances. Treatment options may include:

  • Medications:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications can help reduce menstrual bleeding and relieve pain associated with heavy periods.
  • Hormonal contraceptives: Oral contraceptives (birth control pills), hormonal patches, hormonal IUDs, or contraceptive injections can help regulate menstrual cycles and reduce the heaviness of periods.
  • Tranexamic acid: This medication helps reduce heavy bleeding by promoting blood clotting.
  • Progestin therapy: Progestin-only medications or a progestin-releasing intrauterine device (IUD) can reduce menstrual flow.
  • Gonadotropin-releasing hormone (GnRH) agonists: These medications can temporarily halt menstrual cycles and reduce bleeding, often used for short-term relief.
  • Surgical interventions:
  • Endometrial ablation removes or destroys the uterine lining to reduce menstrual flow.
  • Myomectomy: Surgical removal of uterine fibroids, which can cause heavy periods.
  • Hysterectomy: In severe cases or when fertility is not a concern, the surgical removal of the uterus may be recommended.
  • Iron supplementation:
  • If heavy periods lead to iron deficiency anaemia, iron supplements may be prescribed to replenish iron levels.
  • Lifestyle modifications:
  • Stress management techniques: Stress can exacerbate menstrual symptoms, so managing stress through relaxation techniques, exercise, or counselling may help.
  • Dietary adjustments: Iron-rich foods, such as leafy green vegetables, lean meats, and fortified cereals, can support iron levels.


Treatment choice depends on factors such as the severity of symptoms, underlying causes, desire for future fertility, and individual preferences.


What if Heavy Periods are Untreated?

If left untreated, heavy periods can lead to several complications:

  • Iron-deficiency anaemia: Excessive blood loss can result in low iron levels, leading to anaemia.
  • Fatigue and weakness: Anaemia can cause fatigue, weakness, and decreased quality of life.
  • Emotional and psychological impact: Coping with heavy periods can lead to emotional stress, anxiety, and reduced well-being.
  • Reduced fertility: Some underlying causes of heavy periods, such as polycystic ovary syndrome or endometriosis, can affect fertility if left untreated.


It is crucial to consult with a gynaecologist for an accurate diagnosis and appropriate treatment options tailored to your specific situation. They can help manage the symptoms and improve your overall health and quality of life.

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