Understanding the Reasons Behind Heavy Menstrual Cycles

By: Courtney Lewis

February 15, 2024

women doctor with female patient

While menstrual cycles can be an annoying inconvenience for many women, heavy bleeding (menorrhagia) is not normal and can disrupt your life. A few days of heavy flow at the start of your period is usually nothing to worry about. However, if you’re frequently experiencing very heavy periods, you should discuss it with your gynecologist or primary care provider. 

Dr. Megan Fish, an OB-GYN with Renown Women’s Health, discusses various reasons, evaluation and treatment methods when it comes to heavy menstrual cycles. 

What is classified as heavy menstrual bleeding? 

The American College of Obstetricians and Gynecologists considers heavy bleeding to be any of the following signs:

  • 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.

What are the most common reasons for heavier periods? 

A variety of reasons why someone might have heavy periods. Fortunately, most of these problems are treatable. Because each woman's period is unique, only a doctor can definitively determine the cause of your heavy periods. Some of the most common issues that cause heavy periods include:

  • Hormone imbalances such as anovulation, thyroid disease and Polycystic Ovary Syndrome (PCOS).
  • Structural abnormalities in your uterus such as polyps or fibroids
  • Precancer and cancer such as uterine, cervical, vaginal, ovarian or endometrial hyperplasia
  • Infections such as chlamydia, gonorrhea, endometritis or vaginitis.
  • Other medical conditions such as liver disease, kidney disease or Pelvic Inflammatory Disease.
  • Medications such as blood thinners and aspirin, hormone replacement therapy, Intrauterine devices (IUDs), birth control pills and injectables.
  • Pregnancy-related problems such as a miscarriage or ectopic pregnancy.

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How will a provider evaluate heavy bleeding? 

When you visit your gynecologist or primary care provider about heavy bleeding, they may ask you about:

  • Past and present illnesses and surgical procedures
  • Pregnancy history
  • Medications
  • Your birth control method 
  • Your menstrual cycle history 

Your provider may also conduct a screening such as a pregnancy test, pelvic exam, ultrasound, blood- work or an endometrial biopsy. This will allow them to properly diagnose and treat your heavy or prolonged menstrual bleeding. 

Treating heavy menstrual bleeding

Your provider’s recommended course of treatment is based on several factors, including: 

  • Your overall health and medical history.
  • The cause of the condition and how serious it is.
  • How well you tolerate certain medicines or procedures.
  • The chance that your periods will soon become less heavy.
  • Your plans to have children.
  • How the condition affects your lifestyle.
  • Your opinion or personal choices.

You may be prescribed a medication or a new contraceptive method. In some cases, a surgical procedure is necessary to identify and eliminate the source of bleeding. 

If you are experiencing heavy periods, you should make an appointment with your gynecologist or primary care provider so you can better understand why since there are numerous causes of heavy periods. If you have any questions you want to ask during your appointment, it’s helpful to write them all down and bring them with you.

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