Patient education: Heavy periods (The Basics)

What causes heavy periods? — There are many different causes, including:

●1 of the ovaries not releasing an egg during 1 or more months

●Growths in the uterus called "fibroids"

●A bleeding disorder that prevents the blood from clotting normally

●Side effects of some medicines, such as "blood thinners" or the copper intrauterine device ("IUD")

●A problem with the thyroid (a gland that makes hormones)

●Cancer of the uterus

How much bleeding is abnormal? — Doctors define "heavy" periods as bleeding so much that it affects your health or daily life.

Signs that your periods are too heavy include:

●Soaking through a pad or tampon every 1 or 2 hours, or having to change your pad or tampon during the night

●Passing large lumps, or "clots," of blood

●Bleeding in between periods

●Symptoms of anemia – This is a problem that can happen if you lose too much iron through bleeding. Symptoms can include feeling tired or weak, shortness of breath, and headaches.

Is my bleeding an emergency? — See your doctor or go to the emergency department right away if you soak through 2 pads or tampons in 1 hour for 2 hours in a row.

If you are pregnant and have any bleeding, tell your doctor or midwife right away. Bleeding during pregnancy can sometimes be a sign of an emergency condition.

Will I need tests? — It depends on your age, symptoms, and individual situation. There are lots of tests, but you might not need any.

The most common tests doctors use to find the cause of heavy periods are:

●Blood tests – These can check if you are pregnant. They can also check for low iron levels, a bleeding disorder, or other problems.

●Endometrial biopsy – The doctor takes a sample of tissue from inside your uterus. The sample is viewed under a microscope to look for problems.

●Pelvic ultrasound – This uses sound waves to make a picture of your uterus, ovaries, and vagina. The pictures can show if you have fibroids or other growths.

●Hysteroscopy – The doctor uses a small instrument to look inside your uterus.

How are heavy periods treated? — It depends on what is causing your heavy periods and whether you want to get pregnant soon. You might not need treatment. If you do, treatments might include:

●Birth control methods that contain hormones – These make your period lighter or stop your periods completely. They come as:

•Pills

•Skin patches

•A ring you put inside your vagina

•Shots you get every 3 months

•An IUD your doctor inserts into your uterus

●Medicines that help slow bleeding, such as tranexamic acid (sample brand name: Cyklokapron)

●Medicines that reduce inflammation, such as ibuprofen (sample brand names: Motrin, Advil) or mefenamic acid (brand name: Ponstel)

●Medicines that contain a hormone called "progestin" – These are taken for a week or so every few months.

●Medicines that make the ovaries stop working for a short time

If you have fibroids, or if medicines haven't helped with your heavy periods, your doctor might suggest surgery. Your options depend on whether you might want to get pregnant in the future. They might include:

●Removing fibroids or other growths

●Endometrial ablation – This procedure causes scarring in the inner lining of the uterus.

●Uterine artery embolization – This procedure blocks the blood vessels that supply blood to the uterus.

●Hysterectomy – This is surgery to remove the uterus. After a hysterectomy, you no longer have periods at all.

When should I call the doctor? — Call your doctor or nurse if you:

●Are pregnant or think that you could be pregnant

●Are having trouble getting pregnant

●Are bothered by your bleeding, for example, if you:

•Have periods that last for more than 8 days

•Soak through a pad or tampon every 1 or 2 hours every time you have your period

•Need to use both a pad and a tampon at the same time because you are bleeding so much

•Need to change your pad or tampon during the night

•Pass clots

•Bleed in between periods

•Get your period more or less often than once a month

●Have pain and bad cramps in your lower belly before or while you are bleeding

●Have bleeding after you have not had periods for at least a year, and think that you have gone through menopause

●Have heavy bleeding plus any signs of low iron, such as:

•Feeling weak

•Feeling very tired

•Having headaches

•Having trouble breathing when you exercise

•Feeling your heart beat too fast when you exercise

More on this topic

Patient education: Absent or irregular periods (The Basics)
Patient education: Painful periods (The Basics)
Patient education: Menstruation (The Basics)
Patient education: Uterine fibroids (The Basics)
Patient education: Endometrial ablation (The Basics)
Patient education: Hormonal birth control (The Basics)
Patient education: Long-acting methods of birth control (The Basics)
Patient education: Pelvic ultrasound (The Basics)
Patient education: Hysteroscopy (The Basics)

Patient education: Heavy periods (Beyond the Basics)
Patient education: Uterine fibroids (Beyond the Basics)
Patient education: Hormonal methods of birth control (Beyond the Basics)