Heavy periods

Many women have menstrual problems such as pain, cramping and irregular or heavy bleeding. Very heavy periods are often also associated with other symptoms and can be very distressing. They are not all that rare. About 1 out of 20 women between the ages of 30 and 40 seek medical advice because they have heavy periods. This video is about very heavy periods.

But how do you know if your periods are too heavy?

Women usually lose about 2 ounces of menstrual blood during their period. That is about 60 milliliters or about a third of a small plastic cup. With that amount of bleeding, it takes 4 hours on average before a normal tampon or a sanitary pad becomes fully soaked. A woman is considered to have very heavy periods if she regularly loses more than 80 milliliters or 2.7 ounces of menstrual blood during her period. But how do you know how much blood you have lost? The following things might be signs that you have heavy periods:

  • If you have to change your tampons or sanitary pads after less than 2 hours
  • If you have to use more than 5 sanitary pads or tampons per day
  • If you can see thick clumps of blood in your menstrual flow
  • If you feel weak or tired during your period

It might be helpful to keep a diary over two or three menstrual cycles and note important things, like how painful your periods are, and how many tampons or pads you use.

What causes heavy periods?

The most common reason why women have heavy periods is because their womb cannot contract properly. This can happen if there are non-cancerous growths in the womb, such as myomas or polyps. Contraceptive coils can also prevent the womb muscles from contracting properly.

Other causes include endometriosis, hormonal changes at the beginning of the menopause and low levels of progesterone. Progesterone is a hormone which regulates the thickening and shedding of the womb lining. Sometimes, though, no clear cause can be found.

How are women affected?

Heavy periods can lead to anemia. Signs of anemia include: Weakness and exhaustion, Pale skin, Cold hands and feet, Lightheadedness or dizziness, Shortness of breath or palpitations during physical exertion and Susceptibility to infections, for example fungal infections.

Heavy periods can lead to mental and social stress too. Some women feel worried or scared. They may not dare to leave the house, because they constantly have to change their pads or tampons and aren’t sure to be able to reach a bathroom in time when out and about. They feel embarrassed about blood stains on their clothing and on seats.

Which diagnostic examinations are important?

To find out what is causing heavy periods the womb is usually examined first. The doctor will use his or her hands to feel for any non-cancerous growths in the womb. Then, he or she will take a closer look at the womb using an ultrasound device. To find out whether heavy periods have led to anemia, the doctor can take a blood sample and determine the red blood cell count and iron levels. Sometimes, the level of certain hormones in the blood is measured too.

What are the treatment options?

The hormones that are found in the contraceptive pill affect the menstrual cycle. One thing that they do is stop the lining of the womb from thickening as much as it normally would. That’s why most women who take the pill have lighter periods. Sometimes, non-hormonal contraceptive coils can lead to heavy periods. Hormone-releasing coils, however, work in a similar way to birth control pills. They make the lining of the womb build up less, which means they can be used to treat heavy periods.

Myomas, polyps or other non-cancerous growths in the womb can be removed through surgery. Another treatment option is to remove or destroy the lining of the womb. This is called endometrial resection or ablation.
The complete removal of the womb is only considered if the symptoms are very severe and distressing. This is a major operation, which can have physical and mental side effects.

There are also medications that increase the clotting ability of blood and certain painkillers that can reduce bleeding as well. There is no scientific proof that herbal treatments help.

What can women do themselves?

Some women find that relaxation techniques or yoga help them to relax. Others feel better when they do a lot of exercise and sports. The following things might make it easier to cope with heavy periods:

  • Using a combination of sanitary pads and tampons on heavy days.
  • Wearing dark trousers or skirts, so that blood stains are less noticeable.
  • Having a supply of tampons, pads and spare underwear in your handbag and at work.
  • Putting a towel or waterproof cover on your bedsheet or matress at night.
  • Allowing yourself more rest during your period and,
  • for example, putting an icepack on your belly. Wrap the icepack in a towel to protect your skin.

Deciding: To treat or not to treat?

If very heavy periods are a real problem for you, treatments can help you to cope better with them. Exactly how distressing they are is something that each woman has to judge for herself. Periods are a normal part of every woman’s life. But if heavy periods are causing problems, there is no need to just put up with it.

The alternative to treatment is to deal with the heavier days as best as possible. Here, it is a good idea to see a doctor and rule out any possible serious causes. It’s also important to make sure that the heavy periods aren’t causing anemia. Iron deficiency, or anemia, has to be treated to avoid serious health consequences.

Photos: Thinkstock: www.thinkstockphotos.de
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Updated on December 17, 2019
Next planned update: 2021

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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