Condition Basics

What are heavy menstrual periods?

It's common to bleed a lot during your menstrual cycle. When you have heavy menstrual periods (also called menorrhagia), you may:

• Pass large blood clots and soak through your usual pads or tampons (soaking 12 or more regular sanitary products in one period or soaking through a regular sanitary product every hour for several hours.)
• Bleed for more than 7 days. (A normal period usually lasts 4 to 6 days.)

Heavy periods can be messy and unpleasant, and they may disrupt your life. But in most cases, they aren't a sign of a serious problem.

Still, it's a good idea to see your doctor. A doctor can suggest treatments to ease your symptoms and make sure that you don't have a serious condition.

What causes them?

A number of things can cause heavy periods. These include:

• A change in hormones. Normally one of your ovaries releases an egg during your menstrual cycle. This is called ovulation. If you don't ovulate, your hormone levels can get out of balance. This can affect the lining in your uterus and may cause heavy bleeding.
• An irritation in the uterus. Certain things can cause this, such as using a copper IUD.
• A growth in the uterus, such as a polyp or fibroid.
• Adenomyosis. This condition occurs when the cells that normally line the uterus grow into the wall of the uterus.
• Some bleeding disorders that prevent blood from clotting properly.
• Certain medicines, such as anticoagulants.

Sometimes a cause can't be found.

In rare cases, heavy periods may be a sign of a serious problem, such as an infection or cancer.

How are they diagnosed?

Your doctor will ask about your menstrual periods and do a pelvic examination. During the examination, your doctor will check for signs of disease, infection, and abnormal growths.

If needed, your doctor may also do one or more tests to find out what's causing heavy periods. These tests may include:

• A Pap test. This can look for signs of infection and changes in the cells of your cervix.
• Blood tests. These can check for anemia, a bleeding disorder, or other problems.
• A pelvic ultrasound. This test can look for any problems in the pelvic area.
• An endometrial biopsy. It can check for abnormal cell changes in the lining of the uterus (endometrium).
• A hysteroscopy. This can check the lining of your uterus to look for the cause of bleeding, such as fibroids.

How are heavy menstrual periods treated?

In most cases, heavy menstrual periods can be managed with medicines or hormone treatments. If those treatments don't help, you may need surgery to help control your bleeding.

Medicine options

Your doctor may suggest that you take a non-steroidal anti-inflammatory drug (NSAID), like ibuprofen (such as Advil or Motrin) or naproxen (such as Aleve). Taking an NSAID can reduce bleeding and pain during your period. But NSAIDs usually don't help as much as hormone treatments.

Hormone treatments that may be prescribed include:

• Birth control pills, patch, or ring. These release two hormones, estrogen and progestin. They prevent pregnancy and also can reduce menstrual bleeding and pain.
• Progestin-only birth control, such as mini-pills, implants, and shots. These types of birth control can reduce bleeding and cramping.
• Progestin pills. These are progestin-only pills that help reduce bleeding but do not prevent pregnancy.
• Hormonal IUD. This is a birth control device that your doctor places inside your uterus. It releases a type of progestin that can reduce bleeding and cramping.

Sometimes doctors prescribe a medicine called tranexamic acid (such as Lysteda). It is not a hormone treatment. It reduces bleeding by helping blood to clot.

Surgery options

You may want to think about surgery if medicines don't help or if you have a growth in your uterus. Your choice will depend partly on whether you want to get pregnant in the future. Surgery options include:

• Hysteroscopy. This procedure is done to diagnose heavy periods. But it can also treat some problems at the same time. For example, fibroids or polyps may be removed during this procedure.
• Endometrial ablation. This procedure destroys the endometrium. This reduces or stops uterine bleeding. But it is not an option if you hope to get pregnant.
• Hysterectomy, a surgery to remove the uterus. This may be an option if heavy bleeding can't be controlled or when the cause of bleeding can't be found and treated. It ends your ability to get pregnant.

How can you care for yourself?

If you have severe cramping during your periods, taking an NSAID such as ibuprofen or naproxen may help. An NSAID works best when you start taking it 1 to 2 days before you expect pain to start. If you don't know when your period will start next, take your first dose as soon as bleeding or cramping starts.

Heavy periods can make you feel weak and run-down and can lead to anemia. Your doctor may suggest that you take an iron supplement if your iron levels are low. You may be able to prevent anemia if you increase the amount of iron in your diet. Foods rich in iron include red meat, shellfish, eggs, and beans.