Menorrhagia (Heavy Menstrual Bleeding)

What is menorrhagia?

Menorrhagia is heavy menstrual bleeding or losing more blood than is typical during menstruation. You may have menorrhagia if you:

• Have periods that last longer than seven days.
• Bleed so much you have to change your pad or tampon every hour for several hours back-to-back.
• Need to wear multiple pads at a time to prevent leaking blood.
• Change pads in the middle of the night.
• Pass blood clots the size of a quarter or larger several times per day.
• Can’t do your normal activities when you have your period.

Most people don’t enjoy getting their menstrual period. But if you have menorrhagia, getting your period is probably downright miserable. It can interfere with your daily life and make it hard to go to work or school. Layering up pads and staying home when you have your period can feel debilitating.

Contact a healthcare provider if any of these scenarios apply to you. They can evaluate your symptoms and figure out what’s causing you to have heavy periods. Then, they can recommend treatment options to manage heavy blood flow during your period.

How common is menorrhagia?

Heavy menstrual bleeding is common, affecting anywhere from 27% to 54% of people who menstruate.

What are signs you’re losing too much blood during your period?

Signs of heavy menstrual bleeding include:

• Periods lasting longer than seven days.
• Passing blood clots that are the size of a quarter or bigger more than once or twice. The blood may appear red, pink, brown or even rust-like.
• Bleeding through one or more tampons or pads each hour for more than two consecutive hours.
• Needing to change a pad or tampon in the middle of the night when you should be sleeping.
• Layering up on tampons or pads to protect against leakage.
• Losing more than 5 tablespoons of blood during your period instead of the typical 2 to 3 tablespoons. (This can be hard to measure, but this is the general guideline for blood loss during your period.)
• Abdominal pain or severe period cramps.
• Feeling tired or being short of breath from losing too much blood (may lead to anemia).

How do you know you have menorrhagia?

Heavy menstrual bleeding interferes with your quality of life. Many people with heavy periods assume that periods are supposed to be inconvenient and uncomfortable. They may have watched people in their families live with heavy periods without seeking care and followed their example. But periods should never cause you to restrict activities or accept inconvenience.

During your period, you should be able to:

• Wear a standard pad or tampon for three to four hours without changing it.
• Wear a single menstrual product without having to double up (wearing two pads or two tampons at the same time) at any point.
• Wear a single overnight pad while you sleep at night.
• Leave your home without having to pack extra bags of pads or clothing changes.
• Live your life as usual without missing work, avoiding going out in public or skipping activities you enjoy.

If your periods are disrupting your life, it’s time to see your provider.

What causes heavy menorrhagia?

Menorrhagia can have many causes, ranging from hormone-related issues to medical conditions or medications.

Hormone imbalances

The hormones that your body produces, like estrogen and progesterone, help regulate your menstrual cycle, including how heavy your periods are. Having a condition that causes your hormones to become imbalanced can lead to heavy period bleeding. Causes include:

• Anovulation.
• Thyroid disease.
• Polycystic ovary syndrome (PCOS).

Weighing more than your ideal body weight can interfere with your body’s hormone production and lead to heavy menstrual bleeding, too. Talk to your healthcare provider about your ideal body weight and if this could be contributing to heavy periods.

Noncancerous growths in your uterus

Benign growths in your uterus and conditions that cause cells in your uterus to grow improperly can cause heavy menstrual bleeding, too. Causes include:

• Polyps.
• Fibroids.
• Adenomyosis.

Infection

Infections, including sexually transmitted infections (STIs) can cause heavy bleeding. These include:

• Trichomoniasis.
• Gonorrhea.
• Chlamydia.
• Chronic endometritis.

Pregnancy complications

Heavy bleeding can be a warning sign of pregnancy complications, such as:

• Miscarriage.
• Ectopic pregnancy.
• C-section niche.

Other medical conditions

Menorrhagia is a symptom associated with various conditions, including bleeding disorders and non-bleeding disorders. Some common medical conditions that can lead to heavy bleeding are:

• von Willebrand disease.
• Liver disease.
• Kidney disease.
• Pelvic inflammatory disease (PID).
• Leukemia or platelet disorders.

Cancerous growths in your uterus

A precancerous condition called endometrial hyperplasia can lead to menorrhagia. Other cancers that affect your reproductive system can also cause heavy menstrual bleeding. These include:

• Uterine cancer.
• Cervical cancer.

Medications

Certain medicines can cause heavy menstrual bleeding, too. These include:

• Blood thinners and aspirin.
• Hormone replacement therapy.
• Tamoxifen (breast cancer drug).
• Intrauterine devices (IUDs).
• Birth control implant.
• Birth control pills and injectables (NuvaRing®, Depo-Provera®, Implanon®).

Forgetting to remove contraceptive devices when it’s time can also cause abnormal uterine bleeding. Make sure you know when it’s time to have your provider remove your IUD or implant to prevent this complication.

What are the risk factors for menorrhagia?

Anyone can get menorrhagia, but it tends to be more common in people who are approaching menopause. You may be more at risk for heavy periods if you have any type of hormonal imbalance or obesity (a body mass index, or BMI, or 30 or more).

What are the complications of heavy menstrual bleeding?

Heavy menstrual bleeding can be serious if you lose so much blood that you show signs of anemia. Anemia can be life-threatening without treatment.

Also, some of the conditions that can cause heavy period bleeding, like cancer, require early medical intervention. Speak with your healthcare provider to discuss any risks related to your period bleeding.

How is menorrhagia diagnosed?

Your healthcare provider will ask a series of questions about your medical history and menstrual cycle to diagnose menorrhagia. They’ll also perform a physical exam and a pelvic exam.

Your provider may ask about:

• Your age when you got your first period.
• The number of days your period lasts.
• The number of days your period is heavy.
• Family members with a history of heavy menstrual bleeding.
• Your pregnancy history and current birth control methods.
• Current medications you’re taking, including over-the-counter (OTC) ones.

Come prepared to talk about your quality of life, too. Your provider needs to know if you’ve been doubling up on menstrual products, avoiding activities or placing restrictions on your life in any way because of heavy periods.

What tests will be done to diagnose menorrhagia?

A pelvic ultrasound is the most common way healthcare providers diagnose menorrhagia. You may have other tests, depending on your age and how severe your symptoms are. Other tests may include:

• A blood test to check for signs of anemia, clotting issues or thyroid disease.
• Transvaginal ultrasound to check the appearance of the organs and tissues in your pelvis.
• Magnetic resonance imaging (MRI) to check for abnormal structures inside your uterus when an ultrasound doesn’t provide enough information.
• A Pap smear to study cells from your cervix for changes that may indicate cancer.
• A cervical culture to test for infection.
• An endometrial biopsy to check uterine tissue for cancer cells or other irregularities.

Other procedures that can help your provider diagnose what’s causing your bleeding include:

• A sonohysterogram (saline-infusion sonography) to check for problems in the lining of your uterus. A sonohysterogram allows your provider to see the inside of your uterus while it’s filled with saline.
• A hysteroscopy to check for polyps, fibroids or other irregular tissue in your uterus. Hysteroscopy allows your provider to inspect your vagina, cervix and uterus. Your provider can remove growths that may be causing your bleeding, like fibroids or polyps, during a hysteroscopy.

What is the best treatment for menorrhagia?

Treatment depends on what’s causing your bleeding, how severe your bleeding is, your health, age and medical history.

In some cases, menorrhagia gets better without needing treatment. This tends to be more common when the cause is due to mild hormonal fluctuations or a condition like overweight or obesity (menorrhagia improves when you reach a weight that’s healthy for you).

Talk with your provider about your health concerns and your goals for treatment so they can recommend the best approach.

Medications to treat heavy menstrual bleeding

Healthcare providers recommend medication before surgical treatment. Some possible options include:

• Iron supplements improve your iron levels.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin can ease your cramps and reduce your bleeding.
• Birth control (pills, vaginal ring, patch, IUDs) may help make your periods more regular and lighten your blood flow.
• Hormone replacement therapy (HRT) can help balance the amount of estrogen and progesterone in your body so that your menstrual flow isn’t as heavy. HRT is often recommended for heavy menstrual bleeding associated with perimenopause but comes with risks that you should discuss with your provider.
• Gonadotropin-releasing hormone (GnRH) agonists and antagonists can temporarily stop or reduce bleeding.
• Desmopressin nasal spray (Stimate®) can stop bleeding associated with von Willebrand disease by helping your blood clot.
• Antifibrinolytic medicines, like tranexamic acid, prevent clots from breaking down and causing excessive bleeding.

Procedures to treat heavy period bleeding

If medication doesn’t improve your symptoms, your provider may recommend a surgical procedure. The type of procedure they recommend depends on the cause of your bleeding. Some possible surgical options are:

• Hysteroscopy. This procedure can diagnose and treat heavy period bleeding. It involves your provider using a thin, lighted tube to see inside your uterus. They can then use surgical tools to remove polyps or other causes of bleeding.
• Dilation and curettage (D&C). A procedure that removes the outermost layer of the lining of your uterus. Your provider can send the tissue to a lab to see what’s causing the bleeding.
• Myomectomy. A procedure that removes fibroids from your uterus.
• Uterine artery embolization (UAE). A procedure that restricts the blood flow from fibroids and tumors.
• Endometrial ablation. A procedure that destroys all or part of the lining of your uterus.
• Hysterectomy. Surgery that removes your uterus and prevents you from having periods or getting pregnant.

Your provider will recommend the treatment that works best to address the cause of your bleeding. Treatment may begin with medication and then progress to minor procedures and surgical options. Speak with your provider to decide which options work best for you.

What happens if menorrhagia goes untreated?

Heavy bleeding can lead to anemia, which can be serious. If you think you have menorrhagia, it’s important to see a healthcare provider to treat it.

Does menorrhagia ever go away?

Yes, it’s possible that menorrhagia can go away without treatment. It’s best to talk to your provider about if this may be the case for you. Menorrhagia may be temporary and get better without medical intervention. But, in many cases, an underlying condition is causing heavy menstrual bleeding. You may not have relief from heavy period bleeding until you get treatment for the condition.

How is heavy period bleeding prevented?

You can’t prevent all causes of heavy period bleeding. But talking with your healthcare provider to get a diagnosis and treatment can help you manage your bleeding so that it doesn’t interfere with your quality of life.

What is the prognosis for living with heavy menstrual bleeding?

Left untreated, heavy periods can interfere with your life. In addition, heavy menstrual bleeding can cause anemia and leave you feeling tired and weak. Other health problems can also arise if you don’t get help. With proper treatment and assistance from your provider, you can manage heavy periods without compromising your well-being.

When do you call your healthcare provider if you suspect heavy period bleeding?

You should call your provider if you’re experiencing the symptoms of heavy menstrual bleeding or anemia, or if your period bleeding is impacting your quality of life. Tracking your periods using a calendar or app can help you identify if your periods are heavier and last longer than usual. Share these notes with your provider.

You should also schedule an appointment if you notice that you’re having to double up on menstrual products or if you’re skipping activities you enjoy when you’re on your period.

Should I go to the ER for menorrhagia?

Heavy periods aren’t usually life-threatening, but they can be if you lose too much blood. Bleeding through two or more tampons or pads each hour for two to three hours in a row is a sign that you should see your provider or seek emergency care.

A note from Cleveland Clinic

Just because heavy periods are common doesn’t mean that you have to live with the discomfort they cause. If managing your blood flow is getting in the way of your emotional and physical well-being, speak with your provider. They can provide a care path that will provide relief and get you back to living the life you want to live, even when you’re on your period.