A couple of heavier flow days at the beginning of your period is normal. We’ve all leaked through a tampon or found a couple blood clots on our pads.
But if you change your sheets in the morning because you bleed through your tampon or pad at night, avoid wearing light-colored clothing during your cycle or cram your purse full of tampons, you could have chronic heavy periods, also known as menorrhagia. In fact, about one in five women experience it.
But what may be causing your heavy periods? How can you tell the difference between normal and heavy menstrual bleeding? Let’s talk about it!
Causes of heavy periods range from lifestyle factors to reproductive conditions
There are many different causes of heavy menstrual bleeding. The good news is that most of these causes are treatable. Because each woman’s period is unique, seeing a doctor is the only way to know for sure what’s causing your heavy periods. The most common causes of heavy periods include:
Life changes can affect how heavy your period is
Our bodies are sensitive to change. Even stress can cause abnormal periods. So it shouldn’t come as a surprise that big life changes may affect your cycle. It’s common to experience heavy period flow after pregnancy or childbirth, or during the time your body transitions to menopause (perimenopause).
Certain medications can cause lighter or heavier periods
Heavy periods are a side effect of some medications, especially blood thinners. And some forms of birth control can affect the length of your menstrual cycle and how much you bleed. For example, using a copper or hormonal intrauterine device (IUD) can cause heavier periods for 3-6 months. Talk to your doctor if you notice changes to your period after starting a medication or birth control.
Hormonal imbalances can make periods heavier for some women
Too much or too little estrogen and progesterone can cause menorrhagia. Some women experience high levels of estrogen and low levels of progesterone. This can cause the uterine lining to thicken. When a thick uterine lining sheds during menstruation, women might experience heavier flows and larger blood clots.
Reproductive health conditions can have heavy, painful period symptoms
Several reproductive health conditions can impact your period. Since these conditions can affect the structure and function of reproductive organs they can cause menstruation issues, like heavy bleeding.
Uterine fibroids
Uterine fibroids are small, noncancerous growths inside the uterus. Many women who have fibroids don’t experience symptoms, but if they do, heavy bleeding is one of the most common symptoms of uterine fibroids.
If your doctor finds fibroids in your uterus, they might recommend treatment options for uterine fibroids, including watchful waiting and procedures to remove them.
Endometriosis
Endometriosis is a painful condition that causes tissue that is similar to the uterine lining to grow outside of the uterus. It can cause short period cycles and heavy, painful periods because endometriosis-related growths in other areas of the body don’t shed during your period. About one in 10 women in the United States has endometriosis.
Polycystic ovary syndrome
Polycystic ovary syndrome, or PCOS, is a medical condition caused by a hormonal imbalance in the ovaries. This hormonal imbalance can prevent regular ovulation. So, those with PCOS often experience irregular menstrual cycles, which can include heavy bleeding during periods for some women.
What is considered a heavy period?
Since each body is different, it can be tricky to know what’s “normal” for your cycle. What’s considered a heavy period? It’s hard to tell, and half of women who experience menorrhagia don’t actually know they have it.
Signs that you’re losing excessive blood during your period
The best way to figure out if you’re experiencing chronically heavy period bleeding is to talk to a doctor. But there are some general signs that point toward menorrhagia. According to the American College of Obstetricians and Gynecologists, any of the following is considered a symptom of heavy menstrual bleeding:
- Bleeding for more than seven days
- Bleeding through one or more tampons or pads every hour
- You need to change your pad or tampon during the night
- You need to double up on protection to keep from leaking
- You notice large blood clots during your period (the size of a quarter or bigger)
If left untreated, heavy period bleeding can also lead to anemia, which is when you don’t have enough red blood cells to circulate the amount of oxygen your body needs. This can cause other physical symptoms, such as:
- Fatigue
- Lightheadedness
- Shortness of breath
How heavy menstrual bleeding is diagnosed
Diagnosing menorrhagia has two parts: confirming that your bleeding is unusually heavy and identifying the underlying cause.
For the first part, your doctor will ask you questions about your medical and menstrual history. Then, to identify the cause of the heavy bleeding, one or more tests may be used. Examples include:
- Blood test, to check hormone levels and look for signs of anemia or clotting issues.
- Pap test, where cells from your cervix are examined for signs of infection, inflammation or other unusual changes.
- Endometrial biopsy, which involves looking at samples from your uterine lining to see if any unusual or cancerous cells are present.
- Ultrasound, which uses sound waves to check for dysfunction in the pelvic organs, as well as blood flow issues.
- Sonohysterogram, another kind of ultrasound that’s done while your uterus is filled with liquid to get a better look at the uterine lining.
- Hysteroscopy, where a very small, flexible camera is used to examine the uterus for fibroids, polyps and other possible causes of bleeding issues.
When to see a doctor for heavy period symptoms
Heavy periods aren’t something that you have to manage by yourself. If your period affects your daily life by causing you to miss work or school, cancel social activities or plan your day around bathroom breaks, make an appointment with a women’s health expert or a primary care doctor. At HealthPartners, you can choose from in-person or video visit options.
Women’s health experts like OB-GYNs specialize in female reproductive health, including heavy periods. And primary care doctors can diagnose and treat hundreds of conditions, as well as connect you with a specialist if more advanced care is needed.