Heavy Menstrual Bleeding

What is considered heavy menstrual bleeding?

During a normal menstrual cycle, most women pass about an ounce of blood. But women with heavy menstrual bleeding lose three or more ounces of blood during each period. Since it's impossible to measure the amount of blood you're passing, there are more practical ways to determine if your flow is excessive:

• You find yourself wearing both pads and tampons to control the flow of blood and prevent leakage.
• You must change your protection during the night, often several times a night.
• You pass clots.
• You must change your protection every couple of hours or more frequently.
• Your periods extend beyond seven days.

Women who have heavy menstrual bleeding are also at an increased risk for anemia and fatigue.

What causes heavy menstrual bleeding?

The most common cause of heavy menstrual bleeding is a condition called menorrhagia, which develops as a result of hormonal changes that take place during perimenopause, the time just before menopause occurs. Other possible causes include:

• Uterine fibroids
• Ectopic pregnancy
• IUD-related issues
• Pelvic inflammatory disease
• Some cancers
• Use of blood thinners or anticoagulant medications
• Thyroid disease

Sometimes, menstrual bleeding can be so heavy, it can interfere with sleep and other normal activities of daily living.

How is the cause of heavy menstrual bleeding diagnosed?

Diagnosis begins with a pelvic exam and Pap test. Depending on the results, your medical history and other factors, lab tests, additional examinations and diagnostic imaging including ultrasound may also be ordered.

How is heavy menstrual bleeding treated?

Treatment for heavy bleeding depends on the underlying cause, and can include:

• Hormone therapy to help regulate menstruation
• Medicine to decrease the amount of blood lost during a period
• Fibroid removal
• Minimally-invasive procedures to erase the uterine lining

If menorrhagia is causing anemia, iron supplements may also be prescribed.

*Individual results may vary