Heavy Menstrual Bleeding


How Common is Heavy Menstrual Bleeding?

Heavy menstrual bleeding is very common. About one-third of women seek treatment for it. Heavy menstrual bleeding is not normal. It can disrupt your life and may be a sign of a more serious health problem. If you are worried that your menstrual bleeding is too heavy, tell your obstetrician–gynecologist (ob-gyn).

When is Menstrual Bleeding Considered "Heavy"?

Any of the following is considered to be heavy menstrual bleeding:

  • Bleeding that lasts more than 7 days.
  • Bleeding that soaks through one or more tampons or pads every hour for several hours in a row.
  • Needing to wear more than one pad at a time to control menstrual flow.
  • Needing to change pads or tampons during the night.
  • Menstrual flow with blood clots that are as big as a quarter or larger.


How Can Heavy Menstrual Bleeding Affect My Health?

Heavy menstrual bleeding may be a sign of an underlying health problem that needs treatment. Blood loss from heavy periods also can lead to a condition called iron-deficiency anemia. Severe anemia can cause shortness of breath and increase the risk of heart problems.

What Causes Heavy Menstrual Bleeding?

Many things can cause heavy menstrual bleeding. Some of the causes include the following:

  • Fibroids and polyps
  • Adenomyosis
  • Irregular ovulation—If you do not ovulate regularly, areas of the endometrium (the lining of the uterus) can become too thick. This condition is common during puberty and perimenopause. It also can occur in women with certain medical conditions, such as polycystic ovary syndrome and hypothyroidism.
  • Bleeding disorders—When the blood does not clot properly, it can cause heavy bleeding.
  • Medications—Blood thinners and aspirin can cause heavy menstrual bleeding. The copper intrauterine device (IUD)can cause heavier menstrual bleeding, especially during the first year of use.
  • Cancer—Heavy menstrual bleeding can be an early sign of endometrial cancer. Most cases of endometrial cancer are diagnosed in women in their mid 60s who are past menopause. It often is diagnosed at an early stage when treatment is the most effective.
  • Other causes—Endometriosis can cause heavy menstrual bleeding. Other causes include those related to pregnancy, such as ectopic pregnancy and miscarriage. Pelvic inflammatory disease also can cause heavy menstrual bleeding. Sometimes, the cause is not known.


How is Heavy Menstrual Bleeding Evaluated?

When you see your ob-gyn about heavy menstrual bleeding, you may be asked about the following things:

  • Past and present illnesses and surgical procedures
  • Pregnancy history
  • Medications, including those you buy over the counter
  • Your birth control method
  • Your menstrual cycle—If you can, use a calendar or period-tracking smartphone app to keep track of your menstrual cycle before your visit. Your ob-gyn will want to know detailed information about several menstrual cycles, including the dates that your period started, how long bleeding lasted, and the amount of flow (light, medium, heavy, or spotting).


What Tests and Exams May Be Used to Evaluate Heavy Menstrual Bleeding?

You will have a physical exam, including a pelvic exam. Several laboratory tests may be done. You may have a pregnancy test and tests for some sexually transmitted infections. Based on your symptoms and your age, additional tests may be needed:

  • Ultrasound exam—Sound waves are used to make a picture of the pelvic organs.
  • Hysteroscopy—A thin, lighted scope is inserted into the uterus through the opening of the cervix. It allows your ob-gyn to see the inside of the uterus.
  • Endometrial biopsy—A sample of the endometrium is removed and looked at under a microscope. Sometimes hysteroscopy is used to guide this test. A surgical procedure called dilation and curettage (D&C) is another way this test can be done.
  • Sonohysterography—Fluid is placed in the uterus through a thin tube while ultrasound images are made of the uterus.
  • Magnetic resonance imaging—This imaging test uses powerful magnets to create images of the internal organs.


Which Medications Can Be Used to Treat Heavy Menstrual Bleeding?

Medications often are tried first to treat heavy menstrual bleeding:

  • Heavy bleeding caused by problems with ovulation, endometriosis, polycystic ovary syndrome, and fibroids often can be managed with certain hormonal birth control methods. Depending on the type, these methods can lighten menstrual flow, help make periods more regular, or even stop bleeding completely.
  • Hormone therapy can be helpful for heavy menstrual bleeding that occurs during perimenopause. Before deciding to use hormone therapy, it is important to weigh the benefits and risks (increased risk of heart attack, stroke, and cancer).
  • Gonadotropin-releasing hormone (GnRH) agonists stop the menstrual cycle and reduce the size of fibroids. They are used only for short periods (less than 6 months).
  • Their effect on fibroids is temporary. Once you stop taking the drug, fibroids usually return to their original size.
  • Tranexamic acid is a prescription medication that treats heavy menstrual bleeding. It comes in a tablet and is taken each month at the start of the menstrual period.
  • Nonsteroidal antiinflammatory drugs, such as ibuprofen, also may help control heavy bleeding and relieve menstrual cramps.
  • If you have a bleeding disorder, your treatment may include special medications to help your blood clot.


Which Procedures are Used to Treat Heavy Menstrual Bleeding?

If medication does not reduce your bleeding, a surgical procedure may be needed:

  • Endometrial ablation destroys the lining of the uterus. It stops or reduces menstrual bleeding. Pregnancy is not likely after ablation, but it can happen. If it does, the risk of serious complications is greatly increased. You will need to use a birth control method until after menopause following endometrial ablation. Sterilization (permanent birth control) may be a good option to prevent pregnancy for women having ablation. Endometrial ablation should be considered only after medication or other therapies have not worked.
  • Uterine artery embolization (UAE) is used to treat fibroids. In UAE, the blood vessels to the uterus are blocked, which stops the blood flow that allows fibroids to grow.
  • Myomectomy is surgery to remove fibroids without removing the uterus.
  • Hysteroscopy can be used to remove fibroids or stop bleeding caused by fibroids in some cases.
  • Hysterectomy is surgical removal of the uterus. Hysterectomy is used to treat fibroids and adenomyosis when other types of treatment have failed or are not an option. It also is used to treat endometrial cancer. After the uterus is removed, a woman can no longer get pregnant and will no longer have periods.