Menstruation: Heavy Bleeding

What is heavy menstrual bleeding?

Menstrual bleeding is considered to be heavy or lasting longer than normal if:

  • It is much heavier than usual, possibly with large clots the size of a quarter or bigger.
  • It lasts longer than 7 days.
  • You have to change pads or tampons more often than once an hour.

If you have unusually heavy bleeding for 2 periods in a row, talk to your healthcare provider about it.

The medical term for this problem is menorrhagia.

How does it occur?

There are many possible causes of menorrhagia, including:

  • hormone imbalance, which is the most common cause (the imbalance is sometimes caused by improper use of hormone medicine)
  • polyps, which are growths on the cervix or inside the uterus (polyps are usually not cancerous)
  • fibroids, which are usually noncancerous growths in the uterus
  • endometriosis, which is tissue from the lining of the uterus growing outside the uterus
  • a cyst (a sac full of fluid or blood) on the ovary
  • use of an IUD or birth control pills
  • cancer of the uterus or ovary and sometimes cancer of the vagina or cervix (the opening of the uterus into the vagina)
  • chronic medical problems (for example, thyroid problems, diabetes, and blood-clotting problems)
  • some medicines, such as blood thinners
  • stress

How is it diagnosed?

Your healthcare provider will ask about your medical history and menstrual cycles. Your provider may ask you to keep a diary of bleeding and nonbleeding days, including notes about how heavy the bleeding was. You will also have a physical exam. You may have blood tests. You may have other tests that let your provider take samples of tissue from the uterus or look inside it, such as:

  • Endometrial biopsy: Your healthcare provider takes a sample of tissue from the inside of the uterus. The tissue is examined under a microscope in the lab.
  • Ultrasound scan: Sound waves are used to get pictures of the uterus, ovaries, and pelvis. The ultrasound probe may be put on your lower abdomen or into your vagina.
  • Sonohysterogram: This is an ultrasound scan done after fluid is put into the uterus through a tube.
  • Hysteroscopy: Your provider puts a thin lighted tube with a camera into the vagina, through the cervix, and into the uterus so he or she can look inside the uterus.
  • Laparoscopy: Your provider puts a thin lighted tube with a camera into your belly and pelvis through a small cut near your bellybutton to look at the pelvic organs.
  • D&C (dilation and curettage): Your provider opens up the cervix and scrapes or suctions tissue from the lining of the uterus. The tissue is examined in the lab.
  • Hysterosalpingogram: Dye is injected into the uterus and fallopian tubes through the cervix. X-rays are then taken. The dye outlines the shape and size of the uterus and tubes on the X-ray pictures.

Many of these procedures may be done in your healthcare provider's office. Others may be done in an outpatient clinic.

How is it treated?

The treatment depends on the cause of the problem. For example, if it is caused by an IUD, the IUD will be removed. If you have a hormone imbalance, your healthcare provider may prescribe hormones. If you are already taking hormones, your provider may prescribe a change in your medicine.

Taking a nonsteroidal anti-inflammatory drug, such as ibuprofen or naproxen, may help control heavy bleeding. Nonsteroidal anti-inflammatory medicines (NSAIDs) may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days for any reason.

Sometimes surgery is needed. Possible surgical treatments include:

  • D&C to remove tissue from the uterus
  • hysteroscopy to remove a polyp
  • endometrial ablation to destroy the inside lining of the uterus with a laser, electrical current, thermal balloon, or microwave energy
  • hysterectomy to remove the uterus

Hysterectomy and endometrial ablation are procedures that will make you sterile. That means you will no longer be able to get pregnant. If you have a hysterectomy, you will stop having menstrual periods. After endometrial ablation you should have no or very little menstrual bleeding, although some women start having menstrual bleeding again a while after the procedure.

Hysterectomy and endometrial ablation are usually done after medical treatments, such as hormones and ibuprofen, have not worked.

How long will the effects last?

How long you have abnormal bleeding depends on the cause and treatment.

How can I take care of myself?

  • Follow the treatment recommended by your healthcare provider.
  • Avoid taking aspirin because it could make you bleed more.
  • Rest more during your period. Put your feet up and avoid heavy manual work.
  • Keep a record of how many sanitary pads or tampons you use by the hour and each day.
  • Eat a healthy diet. Make sure you get enough iron.
  • Keep a healthy weight. If you are overweight, try to slowly lose some weight.
  • Get regular exercise when you are not having your period.
  • Practice relaxation techniques, such as yoga and meditation.

Written by Anthony Angello, MD.
Published by RelayHealth.
© 2012 RelayHealth and/or its affiliates. All rights reserved.

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