Heavy menstrual cycles
How common is heavy menstrual bleeding?
Heavy menstrual bleeding is very common. About one third of women seek treatment for it. Heavy menstrual bleeding is not normal. It can disrupt your life and may be a sign of a more serious health problem. Please let us know if you are worried that your menstrual bleeding is too heavy.When is menstrual bleeding considered “heavy”?
- Bleeding that lasts more than 7 days.
- Bleeding that soaks through one or more tampons or pads every hour for several hours in a row.
- Needing to wear more than one pad at a time to control menstrual flow.
- Needing to change pads or tampons during the night.
- Menstrual flow with blood clots that are as big as a quarter or larger.
How can heavy menstrual bleeding affect my health?
Heavy menstrual bleeding may be a sign of an underlying health problem that needs treatment. Blood loss from heavy periods also can lead to a condition called iron-deficiency anemia. Severe anemia can cause shortness of breath and increase the risk of heart problems.
What causes heavy menstrual bleeding?
Many things can cause heavy menstrual bleeding. Some of the causes include the following:
- Fibroids and polyps
- Irregular ovulation—If you do not ovulate regularly, areas of the endometrium (the lining of the uterus) can become too thick.
- Bleeding disorders—When the blood does not clot properly, it can cause heavy bleeding.
- Cancer—Heavy menstrual bleeding can be an early sign of endometrial cancer. Most cases of endometrial cancer are diagnosed in women in their mid-60s who are past menopause. It often is diagnosed at an early stage when treatment is the most effective.
- Other causes—Endometriosis can cause heavy menstrual bleeding. Other causes include those related to pregnancy, such as ectopic pregnancy and miscarriage. Pelvic inflammatory disease (PID) also can cause heavy menstrual bleeding. Sometimes, the cause is not known.
How is heavy menstrual bleeding evaluated?
When you see Dr. Nguyen about heavy menstrual bleeding, you may be asked about
- past and present illnesses and surgical procedures
- pregnancy history
- medications, including those you buy over the counter
- your birth control method
- your menstrual cycle—If you can, use a calendar or period-tracking smartphone app to keep track of your cycle before your visit. Your ob-gyn will want to know detailed information about several cycles, including the dates that your period started, how long bleeding lasted, and the amount of flow (light, medium, heavy, or spotting).
What tests and exams may be used to evaluate heavy menstrual bleeding?
You may have a physical exam, including a pelvic exam. Several lab tests may be done. You may have a pregnancy test and tests for some sexually transmitted infections (STIs). Based on your symptoms and your age, additional tests may be needed:
- Ultrasound exam—Sound waves are used to make a picture of the pelvic organs.
- Hysteroscopy—A thin, lighted scope is inserted into the uterus through the opening of the cervix. It allows your ob-gyn to see the inside of the uterus.
- Endometrial biopsy—A sample of the endometrium is removed and looked at under a microscope. Sometimes hysteroscopy is used to guide this test. A surgical procedure called dilation and curettage (D&C) is another way this test can be done.
- Sonohysterography—Fluid is placed in the uterus through a thin tube while ultrasound images are made of the uterus.
- Magnetic resonance imaging (MRI)—This test views internal organs and structures using a strong magnetic field and sound waves.
Which medications can be used to treat heavy menstrual bleeding?
Medications often are tried first to treat heavy menstrual bleeding:
- Heavy bleeding caused by problems with ovulation, endometriosis, PCOS, and fibroids often can be managed with certain hormonal birth control methods.
- Hormone therapy can be helpful for heavy menstrual bleeding that occurs during perimenopause.
- Gonadotropin-releasing hormone (GnRH) agonists stop the menstrual cycle and reduce the size of fibroids. They are used only for short periods (less than 6 months). Their effect on fibroids is temporary. Once you stop taking a GnRH agonist, fibroids usually return to their original size.
- Tranexamic acid is a prescription medication that treats heavy menstrual bleeding. It comes in a tablet and is taken each month at the start of the menstrual period.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, also may help control heavy bleeding and relieve menstrual cramps. If you have a bleeding disorder, your treatment may include special medications to help your blood clot.
Which procedures can be used to treat heavy menstrual bleeding?
If medication does not reduce your bleeding, a surgical procedure may be recommended:
- Endometrial ablation destroys the lining of the uterus. It stops or reduces menstrual bleeding. Pregnancy is not likely after ablation, but it can happen. Endometrial ablation should be considered only after medication or other therapies have not worked.
- Uterine artery embolization (UAE) is used to treat fibroids. In UAE, the blood vessels to the uterus are blocked, which stops the blood flow that allows fibroids to grow.
- Myomectomy is surgery to remove fibroids without removing the uterus. Hysteroscopy can be used to remove fibroids or stop bleeding caused by fibroids in some cases.
- Hysteroscopy can be used to remove fibroids or stop bleeding caused by fibroids in some cases.
- Hysterectomy is surgical removal of the uterus. Hysterectomy is used to treat fibroids and adenomyosis when other types of treatment have failed or are not an option. It also is used to treat endometrial cancer. After the uterus is removed, a woman will no longer have periods and can no longer get pregnant.