Menstruation: Heavy Bleeding

What is heavy menstrual bleeding?

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

  • It’s 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.

What is the cause?

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 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 have a physical exam.

Tests may include:

  • Blood tests
  • Endometrial biopsy, which uses a tiny straw-like tube put through your vagina and into the uterus through the cervix to take a sample of tissue from the inside of the uterus
  • Ultrasound scan, which uses sound waves to show pictures of the pelvic organs. The ultrasound probe may be put on your lower belly or into your vagina.
  • Sonohysterogram, which is an ultrasound scan done after fluid is put into the uterus through a tube
  • Hysteroscopy, which uses a small lighted tube put into your vagina, through the cervix, and into the uterus to examine the inside of the uterus
  • Laparoscopy, which uses a small lighted tube put into the belly through a small cut to look at the organs and tissues inside the belly
  • D&C (dilation and curettage), which uses a tool is used to scrape or suction tissue from the walls of the uterus after widening the cervix
  • Hysterosalpingogram, which uses X-rays and a dye put into your vagina to show the uterus and fallopian tubes

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, microwave energy, or freezing
  • 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 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.
  • Practice relaxation techniques, such as yoga and meditation.

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