Heavy periods

Although it can feel like a lot more at times, the total amount of blood lost during one period is usually about 60 milliliters (around 2 ounces). That's about one-and-a-half shot glasses full. At that rate of bleeding, it takes about four hours for a regular tampon or pad to become fully soaked. But that’s just an average: menstrual flow is heavier on some days than on others.

Doctors consider a woman to have heavy periods if she regularly loses more than 80 milliliters (2.7 ounces) of blood during one menstrual period. The loss of that much blood may or may not affect you, depending on your general physical fitness and other individual factors.

Signs of heavy periods include the following:

• Regularly needing to change pads or tampons after only one or two hours, or already having to empty your menstrual cup after a few hours
• Feeling weak, tired and sluggish when you have your period
• Having many large clumps of blood in your menstrual blood

Some girls have very heavy periods right from the start. In most cases, though, periods only start becoming heavier later on, for example following childbirth or after putting in a contraceptive coil. Hormonal changes, for instance during the time leading up to menopause, can also play a role.

The most common cause of heavy periods is the womb not being able to contract (tighten and squeeze) properly. Contractions of the womb usually help to shed the lining of the womb, which then leaves the body together with a bit of blood. They also help to make sure that the bleeding doesn't go on for too long.

The muscles of the womb can't contract properly if large benign growths such as fibroids or polyps get in the way. Polyps grow in the lining of the womb, and fibroids develop in the muscle layer of the womb. Contraceptive coils can stop the muscles from contracting properly too.

Adhesions (bands of scar tissue) in the womb are also a common cause of heavy periods, and so are inflammations in the womb or the fallopian tubes. These adhesions may be present from birth, or they may result from surgery or severe endometriosis. Malignant growths such as uterine (womb) or cervical cancer are only very rarely the cause of heavy periods.

In rare cases, other medical conditions like hormonal disorders, blood clotting disorders or problems affecting the heart, kidneys, thyroid gland or liver can also cause heavy periods. But sometimes no clear cause can be found.

If a woman loses too much blood during her period, it can lead to iron deficiency. Iron is very important for making red blood cells. If the body doesn't have enough iron, it can't produce enough red blood cells, which leads to anemia.

Red blood cells carry oxygen to the body's organs in the bloodstream. If there's a lack of red blood cells in our blood, our bodies get less oxygen, making us feel weak and tired. Other signs of anemia include a pale complexion, and cold hands and feet. More severe anemia can also cause other symptoms, like breathing difficulties and palpitations (a racing or pounding heart), particularly following physical activity.

First, it is important to find out how much blood is being lost during the menstrual cycle. It may not be possible to measure the exact amount, but it can at least be estimated. One way is to count how many pads or tampons are needed on the different days during one period – or how often you have to empty your menstrual cup. It can help to keep track for one or two months, for example by keeping notes in a diary.

To find out what is causing heavy periods, the womb is usually examined first. The doctor palpates (feels) the womb and does an ultrasound to look at it. Sometimes a hysteroscopy is recommended as well. This is a procedure in which a tiny camera is inserted into the womb.

A blood test can show whether the heavy periods have caused anemia. The test can also measure the amount of certain hormones in the blood that affect the lining of the womb and the menstrual cycle.

Your personal situation and the type of symptoms you notice can give your doctor further important clues about possible causes. So you should tell your doctor about any illnesses you have, illnesses that run in your family, medications you are taking, weight problems and whether you are particularly stressed.

The treatment options for heavy periods depend on the cause:

• Medication: There are special medications that can reduce bleeding. Many women also take painkillers that lower the amount of bleeding a little too. Known as non-steroidal anti-inflammatory drugs (NSAIDs), these medications include ibuprofen and diclofenac. Acetylsalicylic acid (the drug in medicines like Aspirin) is not suitable for treating heavy periods, though.
• Treatment with hormones: Contraceptives like birth control pills or hormonal IUDs (coils) reduce menstrual bleeding by inhibiting the growth of the lining of the womb.
• Surgery: If heavy periods are causing a lot of problems and the woman no longer wants to get pregnant, the lining of the womb can be removed or destroyed (endometrial resection or ablation). The removal of the womb itself (hysterectomy) is a bigger operation. It is only considered if a woman's periods are very heavy and a big problem in everyday life. Surgery can also be used to remove fibroids, polyps or other non-cancerous tissue growths in the womb.

As long as heavy periods aren’t causing anemia, they don’t necessarily need to be treated.

If you are considering treatment for heavy periods, it's important to find out about – and then carefully consider – the advantages and disadvantages of any medications or surgical procedures. Our decision aid summarizes the pros and cons of the various treatment options.

Your treatment options will also depend on whether you still want to have children. The most effective treatments limit a woman's ability to get pregnant – either temporarily, like the pill, or permanently, like the surgical removal of the womb (hysterectomy).

Heavy periods can affect many activities and make you feel tired or exhausted. The bleeding itself can also be bothersome or embarrassing. But there are ways to cope better with it in everyday life. For instance, on days when the bleeding is particularly bad, you could make sure that you're always close to a toilet or you could use a sanitary pad as well as tampons or a menstrual cup. It may be a good idea to always keep some spare sanitary products at work or in your handbag, just in case. Wearing dark trousers or skirts can help if you're worried about getting bloodstains on your clothing.