Menstruation: Heavy Bleeding

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KEY POINTS

• Menstruation is part of the process your body goes through to get ready for the possibility of pregnancy each month. When the uterus sheds its lining, blood flows out of your vagina. This is called your period.
• If you have unusually heavy bleeding, treatment may include pain medication, hormone therapy, or surgery including removal of the uterus.
• Ask your healthcare provider how to take care of yourself at home including what symptoms or problems you should watch for and what to do if you have them.

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What is heavy menstrual bleeding?

Menstruation is part of the process your body goes through to get ready for the possibility of pregnancy each month. Changes in body chemicals called hormones make the menstrual cycle happen. In the first half of the menstrual cycle, levels of the hormone estrogen rise and make the lining of the uterus grow and thicken. The uterus is the muscular organ at the top of the vagina. Babies grow in the uterus, and menstrual blood comes from the uterus. If a man's sperm does not fertilize the egg, hormone levels drop and your uterus sheds the lining it prepared for a baby. When the uterus sheds its lining, blood flows out of your vagina. This is called your period. Your period may last from 2 to 7 days.

Your period may not be the same every month, and it may not be the same as other women's periods. Periods can be light, moderate, or heavy. The amount of blood lost is usually about 2 to 3 tablespoons (29 to 44 ml).

Menstrual bleeding is considered to be heavy or lasting longer than normal if:

• It’s much heavier than usual, possibly with clots the size of a quarter or bigger.
• It lasts longer than 7 days.
• You have to change pads or tampons more often than once an hour.

If you have unusually heavy bleeding for 2 periods in a row, talk to your healthcare provider about it.

What is the cause?

Possible causes of heavy menstrual bleeding include:

• Hormone imbalance, which is the most common cause
• Polyps, which are growths on the cervix or inside the uterus
• Fibroids, which are noncancerous growths in the uterus
• Endometriosis, which is when tissue that forms the lining of the uterus grows outside of the uterus
• A cyst (a fluid-filled sac) on the ovary
• Use of an IUD or birth control pills
• Cancer of the uterus or ovary and sometimes cancer of the vagina or cervix (the opening of the uterus into the vagina)
• Long-term medical problems (for example, thyroid problems, diabetes, and blood-clotting problems)
• Some medicines, such as blood thinners
• Stress

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you, including a pelvic exam. Tests may include:

• Blood tests
• Ultrasound, which uses sound waves to show pictures of the pelvic organs
• Sonohysterogram, which is an ultrasound scan done after fluid is put into the uterus through a tube
• Hysteroscopy, which uses a small lighted tube put into your vagina, through the cervix, and into the uterus to examine the inside of the uterus. A biopsy may be taken to help make a diagnosis. A biopsy is the removal of a small sample of tissue for testing.
• Laparoscopy, which uses a small lighted tube put into the belly through a small cut to look at the organs and tissues inside the belly. A biopsy may be taken to help make a diagnosis.
• Hysterosalpingogram, which uses X-rays and a dye put into your vagina to show the uterus and fallopian tubes

Many of these procedures may be done in your healthcare provider's office. Others may be done in an outpatient clinic.

How is it treated?

The treatment depends on the cause of the problem. For example, if it is caused by an IUD, the IUD will be removed. If you have a hormone imbalance, your healthcare provider may prescribe hormones. If you are already taking hormones, your provider may prescribe a change in your medicine. Your healthcare provider may prescribe an IUD that contains female hormones.

Your provider may suggest that you take nonprescription pain medicine, such as acetaminophen, ibuprofen, or naproxen. Read the label and take as directed. Unless recommended by your healthcare provider, you should not take these medicines for more than 10 days.

• Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age.
• Acetaminophen may cause liver damage or other problems. Unless recommended by your provider, don't take more than 3000 milligrams (mg) in 24 hours. To make sure you don’t take too much, check other medicines you take to see if they also contain acetaminophen. Ask your provider if you need to avoid drinking alcohol while taking this medicine.

Sometimes surgery is needed. Possible surgical treatments include:

• D&C (dilation and curettage), which uses a tool to scrape or suction tissue from the walls of the uterus after widening the cervix. A small sample of the tissue may be sent for testing to help find the cause.
• Hysteroscopy, which uses a small lighted tube and camera to find and remove a polyp
• Endometrial ablation to destroy the inside lining of the uterus with a laser, electrical current, heat, microwave energy, or freezing
• Hysterectomy to remove the uterus

You will not be able to get pregnant if you have a hysterectomy or endometrial ablation. If you have a hysterectomy, you will stop having menstrual periods. After endometrial ablation, you should have no or very little menstrual bleeding, although some women start having menstrual bleeding again a while after the procedure.

Hysterectomy and endometrial ablation are usually done after medical treatments, such as hormones and ibuprofen, have not worked.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. In addition:

• Avoid taking aspirin because it could make you bleed more.
• Keep a record of how many sanitary pads or tampons you use by the hour and each day.
• Take care of your health. Try to get at least 7 to 9 hours of sleep each night. If you smoke, try to quit. If you want to drink alcohol, ask your healthcare provider how much is safe for you to drink. Learn ways to manage stress. Exercise according to your healthcare provider's instructions.
• It may help to rest more during your period. Put your feet up, relax, and avoid heavy manual work.