Heavy periods

Heavy periods


As if the other period-related symptoms weren’t bad enough, add in heavy periods and we are just about ready to throw in the towel on our reproductive organs. Yep, they can be a significant source of discomfort, distress, and inconvenience, leaving many of us dreading aunt flow each month. Heavy menstrual bleeding, known as menorrhagia [1], which literally translates to raging periods, is excessive or prolonged menstrual bleeding. It affects around 25% of people who menstruate [2] and can be severely debilitating. After all, nobody wants to live anxiously worrying about whether their period will leak through their clothes.

What is considered a heavy period?

  • It can be difficult to know for sure if your period is heavy or not, as what is considered "normal" can vary greatly from person to person.
  • According to the American College of Obstetricians and Gynecologists, a heavy period is defined as losing more than 80ml of blood during a menstrual cycle [3, 4].
  • Signs that your period may be heavy include needing to change your menstrual product more frequently than usual, having heavy clots or large clumps of blood, or experiencing fatigue or weakness.
  • Heavy periods should not be overlooked or accepted as normal. It's important to talk to your healthcare provider if you think you may have a heavy period. They can help determine the cause and develop a plan to manage your symptoms.
  • Just because heavy menstrual periods might be common, it should not be accepted as normal, overlooked, or suffered with in silence.

Tip: As a rule of thumb, if something doesn’t feel right when it comes to the body, it probably isn’t. Know that it is okay to go see a doctor. It is okay to ask questions. It is okay to be your own advocate. Remember, you know your body best.

What are the signs of a heavy period?

  • Feeling that you need to change pads, period underwear or tampons at least every hour (and for several hours in a row)
  • The need to use a pad and tampon at the same time
  • More than 7 days of menstrual bleeding
  • Or, according to UK NICE guidelines, any “excessive menstrual blood loss that physically, emotionally, socially and financially affects the quality of life of the woman (person*) and can be seen by itself or with other symptoms” [6].

The most important point to keep in mind is that if your menstrual bleeding affects your daily life in any way, such as causing you to be housebound, interrupting your daily activities, or causing you stress and anxiety, then you should talk with your doctor.

What causes heavy periods?

So, why are my periods so heavy? Well, there are numerous possible causes of heavy bleeding. While some might be simple and easily treated, others might be more serious.

Causes can include:

Uterine-related:

  • Uterine Fibroids: non-cancerous growths or lumps within the uterus wall.
  • Polyps: usually non-cancerous (benign) growths in the endometrium that look like a large 'teardrop' of tissue.
  • Endometriosis: a condition where tissues similar to the uterine lining are found outside the uterus.
  • Adenomyosis: a condition where tissues from the uterine lining grow into the muscular wall of the uterus.

Hormonal-related

  • Polycystic ovary syndrome (PCOS): a condition that impacts how the ovaries work. Periods may be irregular but can also become heavier as the lining has longer to thicken up and there is more built-up to shed away.
  • Thyroid issues: this usually involves an underactive thyroid. The thyroid gland plays a major role in female hormone production and in clotting factors needed to stop the flow of menstrual blood.
  • Bleeding disorders: such as von Willebrand’s disease which is a disorder where there is a deficiency or impairment of an essential blood-clotting factor.
  • Overweight and obesity: fat tissue is a major source of estrogen, which is the hormone that acts by building up the uterine lining. Higher estrogen levels will lead to a thicker uterine lining which can result in a much heavier period.

Other:

  • Certain forms of contraception: Copper coils (a type of intrauterine device that acts as birth control and contains copper), while relatively popular and very effective, can result in heavier periods.
  • Other causes—there may be other causes such as ectopic pregnancy, miscarriage, uterine or pelvic infections (such as pelvic inflammatory disease), certain medications or cancer (endometrial or cervical cancer) [7].

Some of the most common reasons for heavy menstrual bleeding are fibroids (20%–30% of cases) [8], uterine polyps (5%–10% of cases) [9], or endometriosis (5% of cases) [10]. About half of women with heavy periods have no identifiable cause [11] (we know…frustrating!).

Important: if you are experiencing heavy periods…you should know the underlying cause of them!

What are the risks associated with a heavy period?

Not only can heavy menstrual bleeding significantly impact your quality of life (mental state, productivity, relationships, sex life etc.) but it can also indicate that you may have a potential underlying problem that needs to be addressed (12-14). As always, listen to your body, your menstrual cycle is a great indicator of your health. Large amounts of blood loss from heavy periods can also lead to iron deficiency (anemia) [15]. Anemia affects about two-thirds of people with heavy periods and in severe cases, anemia can cause shortness of breath and increase the risk of heart problems [4].

How common is having a heavy period?

Around 1 in 5 women in the UK will experience a heavy period [1]. But do know that the amount of bleeding varies from person to person and can change at different life stages; for example, in teenage years or when approaching menopause.

Should I see a doctor about my heavy periods?

If you think that you might be experiencing heavy menstrual bleeding, the first step is going in to see your healthcare provider. They can help you reign in aunt flow. Yes, it can feel scary to see a doctor about your periods but remember that they are not there to judge you and their goal is to help you. In saying that, if you do feel dismissed or don’t feel that your provider is adequately hearing you, find someone else!

Still have remaining questions about heavy periods? Feel free to ask us anything and we will do our best to address them in an informative and educational way. Remember, knowledge is power.

Ask Zoe

How to stop heavy periods?

Depending on the underlying cause of your heavy menstrual bleeding, your doctor may manage it using [16]:

  • Hormonal birth control
  • Hormone therapy
  • Gonadotropin-releasing hormone
  • Tranexamic acid
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Iron supplements may also be prescribed if you develop signs and symptoms of anemia.If medication does not reduce your bleeding, a surgical procedure may be recommended.
  • How will my doctor evaluate my heavy periods?
  • Your doctor will take a full medical history, ask you about your menstrual periods, menstrual flow and likely perform a pelvic exam. They may also need other tests to find out what is causing your heavy periods such as a blood test, ultrasound, pap test, biopsy, or hysteroscopy.

Stories of heavy periods

Final word:

If you are concerned that you might have heavy periods, don’t suffer in silence - talk to a healthcare professional. Heavy periods are not something you should just have to deal with and there are numerous treatment/management options available. Tracking your period and making note of tampons/pads used may be helpful before you see your doctor. Lastly, we require more dialogue about our periods because when we don’t talk about them, we often don’t know what is normal or abnormal.

References
  • 1. Gunter J. The Vagina Bible: The Vulva and the Vagina -- Separating the Myth from the Medicine: Citadel Press; 2019.
  • 2. Care ACoAH. ACOG Committee Opinion No. 349, November 2006: Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Obstet Gynecol. 2006;108(5):1323-8.
  • 3. Fraser IS, McCarron G, Markham R, Resta T. Blood and total fluid content of menstrual discharge. Obstet Gynecol. 1985;65(2):194-8.
  • 4. Yang H, Zhou B, Prinz M, Siegel D. Proteomic analysis of menstrual blood. Mol Cell Proteomics. 2012;11(10):1024-35.
  • 5. Garg S, Anand T. Menstruation related myths in India: strategies for combating it. J Family Med Prim Care. 2015;4(2):184-6.
  • 6. Johnston-Robledo I, Chrisler JC. The Menstrual Mark: Menstruation as Social Stigma. Sex Roles. 2013;68(1):9-18.
  • 7. Jones MM. Human Reproductive Biology: Elsevier Science; 2012.
  • 8. Dasharathy SS, Mumford SL, Pollack AZ, Perkins NJ, Mattison DR, Wactawski-Wende J, et al. Menstrual bleeding patterns among regularly menstruating women. American journal of epidemiology. 2012;175(6):536-45.
  • 9. Garry R, Hart R, Karthigasu KA, Burke C. A re-appraisal of the morphological changes within the endometrium during menstruation: a hysteroscopic, histological and scanning electron microscopic study. Hum Reprod. 2009;24(6):1393-401.
  • 10. Fraser IS, Critchley HO, Broder M, Munro MG. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med. 2011;29(5):383-90.
  • 11. Sriprasert I, Pakrashi T, Kimble T, Archer DF. Heavy menstrual bleeding diagnosis and medical management. Contracept Reprod Med. 2017;2:20.