Introduction

Many women experience symptoms such as pain, cramps, and irregular or very heavy bleeding during their period. If tampons or sanitary pads need to be changed more than every few hours, the menstrual bleeding may be heavier than normal. It is clearly too heavy if it is affecting your everyday life and the loss of blood is making you feel physically weak.

About 9 to 14 out of 100 women have heavy periods. A period that lasts longer than five to seven days is considered prolonged menstrual bleeding. These two problems commonly occur together because they often have the same underlying cause. The medical term for excessively long or heavy periods is menorrhagia.

Some women have developed useful strategies for dealing with heavy periods. If the bleeding is causing problems or an iron deficiency, for example, then medication to reduce the bleeding may be an option. Surgery is another possibility.

Symptoms

Although it can feel like a lot more at times, the total amount of blood lost during one period is usually about 60 milliliters (around 2.7 ounces). That's about one-and-a-half shot glasses full. At that rate of bleeding, it takes about four hours for a regular tampon or pad to become fully soaked. But that’s just an average: menstrual flow is heavier on some days than on others.

Doctors consider a woman to have heavy periods if she regularly loses more than 80 milliliters of blood during one menstrual period. The loss of that much blood may or may not affect you, depending on your general physical fitness and other individual factors.

Signs of heavy periods include the following:

• Regularly needing to change pads or tampons after only one or two hours
• Soon feeling weak, tired and sluggish when you have your period
• Many large clumps of blood in the menstrual blood

Causes

Some girls have very heavy periods right from the start. In most cases, though, the periods only start becoming heavier later on, for example following childbirth or after using a contraceptive coil. Hormonal changes, for instance during menopause, can also play a role.

The most common cause of heavy periods is the womb not being able to contract properly. Contractions of the womb usually help to shed the lining of the womb, which then leaves the body together with a bit of blood. And they help to make sure that the bleeding doesn't go on for too long.

The muscles of the womb are prevented from contracting properly if larger benign growths such as fibroids or polyps get in the way. Polyps grow in the lining of the womb, while fibroids develop in its layer of muscle. Contraceptive coils can hinder the muscles of the womb too.

Adhesions (bands of scar tissue) in the womb are also a common cause of heavy periods, and so are inflammations in the womb or the fallopian tubes. These adhesions may be present from birth, or they may result from surgery or severe endometriosis. Malignant growths such as uterine (womb) or cervical cancer are only very rarely the cause of heavy periods.

In rare cases, other medical conditions like hormonal disorders, blood clotting disorders or problems affecting the heart, kidneys, thyroid gland or liver can also cause heavy periods. But sometimes no clear cause can be found.

Effects

If a woman loses too much blood during her period, it can lead to iron deficiency. Iron is very important for making red blood cells. If the body doesn't have enough iron, it can't produce enough red blood cells, which leads to anemia.

Red blood cells carry oxygen to the body's organs via the bloodstream. If there is a lack of red blood cells in our blood, our bodies get less oxygen, making us feel weak and tired. Other signs of anemia include a pale complexion, and cold hands and feet. More severe anemia can also cause other symptoms such as breathing difficulties and a racing heart, particularly following strenuous physical activity.

Diagnosis

First, it is important to find out how much blood is being lost during the menstrual cycle. It may not be possible to measure the exact amount, but it can at least be estimated. One way is to go by how many pads or tampons are needed on the different days during one period. It can help to keep track for one or two months, for example by keeping notes in a diary.

To find out what is causing heavy periods, the womb is usually examined first. The doctor palpates (feels) the womb and does an ultrasound to look at it. Sometimes a hysteroscopy is recommended as well. This is a procedure in which a tiny camera is inserted into the womb.

A blood test can show whether the heavy periods have caused anemia. The test can also measure the amount of certain hormones in the blood that are affected by the lining of the womb and the menstrual cycle.

Your personal situation and the type of symptoms you notice can give your doctor useful clues about possible causes too. So you should tell your doctor about any illnesses you have, illnesses that run in your family, medications you are taking, weight problems and whether you are under psychological stress.

Treatment

The treatment options for very heavy periods depend on the cause. Surgery can be carried out to remove fibroids, polyps and other non-cancerous growths from the womb. But many women first try using medication that helps to reduce the bleeding, or certain painkillers that also help to reduce the bleeding a little.

Another option is to use hormonal contraceptives like birth control pills or an intrauterine device (IUD). Both of these contraceptives reduce the bleeding by inhibiting the growth of the lining of the womb.

If heavy periods are causing a lot of problems and the woman no longer wants to get pregnant, the lining of the womb can be removed or destroyed (endometrial resection or ablation). The removal of the womb itself (hysterectomy) is a more major operation. It is only considered if heavy periods are very distressing and really affecting a woman's life.

But as long as the heavy periods have not caused anemia,  women can also choose not to have treatment.

It's important for women who are thinking of having treatment to learn about and carefully consider the pros and cons of any medications or surgical procedures. The possible treatment options will also depend on whether a woman wants to have a (further) child or not. The most effective treatments all limit the woman's ability to get pregnant – either temporarily, like the pill, or permanently, like the surgical removal of the womb (hysterectomy).

Everyday life

Many women who have heavy periods feel weak and tired during their period and shortly afterwards. Women who feel very exhausted may have difficulties coping with the demands of everyday life, whether at home or at work. Even social activities and hobbies that are usually enjoyable can become a burden. Having to change tampons and pads several times during the night can affect your sleep. Sometimes women who have heavy periods also have lower abdominal pain.

But it's not only the physical symptoms due to high blood loss that may be difficult to cope with: Heavy periods can be embarrassing, bothersome (during sex as well) and sometimes worrying too. Some women feel like blood is just “gushing out” of them, or they might find the sensation very unpleasant.

Some feel most comfortable if they stay at home on particularly heavy days. But most women don't mind leaving the house as long as they know that a bathroom is nearby and that they can get to it in time when they need to change tampons or pads. Using a combination of tampons and pads on very heavy days is another option. Always keeping some at work or in your handbag is also a good precaution in case you forget to take them with you.

Wearing dark trousers or skirts on heavy days helps reduce the stress of worrying about obvious stains too. Women who are worried about blood soaking through to their sheets or mattress at night often use an extra layer on their bed, like a waterproof sheet or simply a towel.

Sometimes partners, friends, relatives, colleagues and even doctors don't take menstrual problems seriously. But more serious problems and excessive blood loss are not something that should just be accepted as "natural." Having the feeling that you aren't being taken seriously can make it difficult to feel comfortable about allowing yourself enough rest, seeking professional help or looking for suitable treatment. Although menstruation is a part of every woman's life, if your periods are so heavy that they're affecting your wellbeing, there are things that can be done to provide relief and help you cope better.

Sources

• Duckitt K. Menorrhagia. BMJ Clin Evid 2015.
• Garside R, Britten N, Stein K. The experience of heavy menstrual bleeding: a systematic review and meta-ethnography of qualitative studies. J Adv Nurs 2008; 63(6): 550-562. [PubMed: 18808575]
• Lethaby A, Farquhar C. Treatments for heavy menstrual bleeding. BMJ 2003; 327(7426): 1243-1244. [PMC free article: PMC286237] [PubMed: 14644939]
• National Institute for Health and Care Excellence (NICE). Heavy menstrual bleeding: assessment and management. January 2017. (NICE Guidelines; Volume 44). [PubMed: 29634173]
• O'Flynn N, Britten N. Menorrhagia in general practice – disease or illness. Soc Sci Med 2000; 50(5): 651-661. [PubMed: 10658846]
• Protheroe J, Chew-Graham C. The role of primary care in the diagnosis and management of menorrhagia: A qualitative study of women with menorrhagia. Prim Health Care Res 2005; 6(3): 217-223.
• Santer M, Wyke S, Warner P. What aspects of periods are most bothersome for women reporting heavy menstrual bleeding? Community survey and qualitative study. BMC Womens Health 2007; 7: 8. [PMC free article: PMC1904195] [PubMed: 17543131]
• Santer M, Wyke S, Warner P. Women’s management of menstrual symptoms: Findings from a postal survey and qualitative interviews. Soc Sci Med 2008; 66(2): 276-288. [PubMed: 17920178]

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