Heavy Periods: When Is It More Than Just a Heavy Flow?

Content medically reviewed by Amanda Tran, MD

About 1 in 5 women have heavy periods. This heavy bleeding, called menorrhagia, is more than just needing to change pads or tampons often—it’s the type of bleeding that disrupts your daily life. With menorrhagia, you lose a lot of blood, leading to symptoms like tiredness, weakness and dizziness.

Heavy periods aren’t normal and there’s treatment available to help ease your symptoms.

“If your periods are disruptive, including lasting for longer than a week, you should talk with your doctor,” said Dr. Amanda Tran, a family medicine with obstetrics provider at Essentia Health. “An untreated underlying condition could be the cause, so it’s important to get a diagnosis to begin effective treatment.”

What Is Heavy Bleeding?

Your flow is considered heavy if you lose more than 2.7 ounces of blood during your period. Since most women do not measure their period blood, it can be difficult to know how much blood has been lost.

Everyone's experience is different, but here are some key signs –

• Soaking through one or more pads or tampons every hour for several hours in a row
• Waking at night to change your pad or tampon
• Passing large blood clots bigger than a quarter
• Period that stops you from doing your usual activities, like exercising
• Period that lasts longer than seven days

What Causes Heavy Periods?

Heavy periods can occur without a clear medical reason. However, they can also be a symptom of other health issues. Common causes of heavy periods include –

Endometriosis

Endometriosis develops when tissue similar to the lining of your uterus grows outside of the uterus. This tissue can bleed during your period, leading to heavy bleeding. You may also have pain in your pelvis, pain during sex and fertility issues.

Polycystic Ovary Syndrome (PCOS)

PCOS can cause heavy bleeding during their periods. PCOS causes hormonal imbalances, particularly higher levels of androgens, which can interfere with normal menstrual functions.

Fibroids

Fibroids are noncancerous growths in the uterus. These growths are surrounded by a layer of tissue that contains blood vessels. If these blood vessels break, heavy bleeding may develop during your period.

Bleeding Disorders

If you have a bleeding disorder like von Willebrand disease, a genetic disorder that causes easy bruising, you may also have heavy periods. Your provider may ask you about your family history of bleeding problems when looking into heavy menstrual bleeding.

Thyroid Problems

An underactive thyroid (hypothyroidism) can disrupt your hormones and change your period, sometimes making it heavier.

Diagnosing Heavy Periods

If you believe your periods are heavy, talk with your provider. They will likely ask you about your menstrual cycle, how much and how long you bleed, and any other symptoms you have.

“Before your appointment, keep a note of your flow, such as how many pads or tampons you use in a day, whether you normally see blood clots and if you have other symptoms, like dizziness or shortness of breath during your period,” Dr. Tran said. “This can help your doctor reach an accurate diagnosis.”

To help identify a cause and recommend personalized treatment, your provider may order several diagnostic tests, including –

A Pelvic Exam

A pelvic exam is one of the first steps to diagnosing heavy periods. During this exam, the doctor will check your uterus, ovaries and the surrounding areas for anything unusual, like fibroids or polyps.

Pap Test

You might also have a Pap test during your pelvic exam. This test mainly checks for cervical cancer and precancerous cells. It’s a routine women’s health screening and can rule out any cervical problems that might be contributing to your abnormal bleeding.

Blood Tests

Blood tests can check your hormone levels, screen for thyroid disease and see if you have anemia. If your provider believes you might have a bleeding disorder, they will order specific blood tests to check how your blood clots.

Imaging Tests

An ultrasound can give a better look at your uterus and ovaries and help find fibroids and polyps, or tiny growths. You may also need additional imaging, such as a hysteroscopy, which involves inserting a thin tube into your uterus, or an endometrial biopsy, where a small sample of the uterine lining is taken and examined.

Treating Heavy Periods

The cause of your heavy bleeding determines the treatment. Often, medications like birth control and hormone therapy can help manage your symptoms. In some cases, your provider may recommend surgery, especially if another issue, like polyps or fibroids, is the cause.

Medication

Birth control pills that contain estrogen and progestin can help make your periods regular and lighter. Hormonal intrauterine devices (IUDs) may also be used. These devices are placed in your uterus and release progestin, which makes periods much lighter. IUDs can also make your period stop completely.

Some over-the-counter medications like ibuprofen can help lighten your periods, but not significantly.

Surgery

Surgery can remove fibroids or polyps that cause heavy bleeding. For severe, heavy bleeding that doesn't get better with other treatments, your provider may recommend a hysterectomy. A total hysterectomy removes your uterus and cervix, while a partial hysterectomy removes only the upper part of the uterus.

Dealing with heavy menstrual bleeding can take a toll on your physical and mental health. It's important to know that you don't have to just live with heavy periods. By understanding what's not normal, knowing that conditions like endometriosis could be involved and seeing your provider, you can take charge of your health. There are many effective ways to manage your symptoms.