It can be hard to assess what is “normal” with your monthly period. Most women actually do not shed very much blood when they menstruate. They change their tampon or pad usually only once every few hours. So if your periods are so heavy that you have to go to the toilet very often and you have to think a lot about whether you might soak through your clothes, that is much more than normal. And if the blood loss is interfering with your everyday life and dragging you down, then you are one of the women for whom heavy menstrual bleeding is a real problem. About 1 in 20 women (5%) are affected by what is called menorrhagia or hypermenorrhea.
Many women are not bothered by heavy bleeding, or they have found good strategies to help them manage. Others also look for medical options or consider surgery. We explain these options, as well as coping strategies, in this fact sheet. However, many women with heavy periods also have other problems – their periods go on for too long, or are very irregular, for example. We do not address those other problems here.
What is menorrhagia and how common is it?
The mucous lining of the uterus (womb), called endometrium, changes during the course of the menstrual cycle: It builds up after every monthly period and its blood supply increases so that a fertilized egg cell can settle in the uterus and grow there. If the egg cell is not fertilized, the mucous membrane is shed with the next menstruation. Although this is often called “menstrual bleeding”, the body not only loses blood during the period, but also parts of the endometrium.
Even though menstrual blood may look like a lot when it is on a pad or a tampon, normally only about 20 to 60 ml of blood are shed during the monthly period: that is only 4 to 12 teaspoons. At that rate of bleeding, it takes about 4 hours for a regular tampon or pad to become full. That is just an average: it is also normal for some days to be heavier than others.
In gynecology, a woman has menorrhagia if she regularly loses more than 80 ml blood during a period. Which amount of blood is felt to be too high is a very individual matter, though: for some women, less than 80 ml can make life difficult, while for others even much larger amounts cause no real bother. Regardless of the exact amount of blood lost, in heavy menstrual bleeding help may be needed when women feel so bad that their everyday activities are affected. If you notice that your periods are often a lot heavier than they used to be or if they bother you a lot more, you may have menorrhagia. About 5% of women between the ages of 30 and 49 go to the doctor looking for help for heavy menstrual bleeding. That is about 1 in every 20 women.
The rule of thumb is: If it is common for you to soak through a pad or tampon in an hour (or sometimes even faster) and you get weak and tired easily, then that might be very heavy menstrual bleeding. If you have a lot of big blood clots in your menstrual flow, then that also means you are shedding a lot of blood.
What causes heavy periods?
Some women have heavy periods right from the start, but many women’s periods only become heavier later on in life. The hormonal changes in the time leading up to the menopause can also be a factor. One common reason for heavy menstrual bleeding is the growth of too much tissue in the uterus. These growths are usually benign.
There are two main types of benign growths that can cause heavy periods:
- Polyps: little soft growths in the endometrium and
- Fibroids (also called myomas): growths in the muscle layer of the uterus.
These kind of growths in the endometrium or muscle layer of the womb are fairly common and often do not cause any symptoms. Very rarely, malignant (cancerous) growths like uterine or cervical cancer can lead to heavy bleeding, too. There are also some other less common causes, such as hormone problems.
Less frequently heavy periods can be caused by other, less common medical conditions like bleeding disorders or problems in the heart, kidneys, thyroid gland or liver. But it is not always possible to pinpoint what is causing heavy menstrual bleeding.
What are the physical effects of heavy periods?
When a woman loses a lot of menstrual blood during her period, this can lead to iron deficiency. Iron is very important for building red blood cells. If the body does not have enough iron, it cannot produce enough red blood cells, which leads to anemia.
We need red blood cells to carry inhaled oxygen to our organs so that they can work properly. If there is 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 a racing heart, particularly following physical activity. A doctor can find out if you have anemia by doing a blood test.
Even if heavy menstrual bleeding does not cause anemia, affected women often feel weak and sluggish when they have their period. Their symptoms are similar to anemia, although generally not quite as strong.
How do other women feel about heavy periods?
It is not only the physical symptoms due to high blood loss that are sometimes difficult to cope with: heavy periods can be embarrassing, annoying and sometimes they can be scary. Some women feel like blood is just “flowing out” of them, and the feeling can be very unpleasant.
If women feel very tired, it can be difficult for them to cope with everyday demands at home or at work. Even social activities and hobbies that are usually enjoyable can then become a burden. Some women who have heavy periods experience mood swings and/or anxieties. It can cause problems sleeping, too.
Sometimes friends, relatives, colleagues and even doctors do not take menorrhagia seriously. That does not help. If you are always told that menstrual bleeding is natural and not a medical condition, you may find it hard to take some time out to relax, seek medical advice or look for a suitable treatment. Even if menstruation is a part of life for women, if heavy periods are affecting your quality of life, there are things you can do to get some relief and help you cope with it.
How do other women cope with heavy periods in everyday life?
Although some women have some days where the bleeding is so bad, they need to stay at home, mostly women manage by making sure they keep an eye out for toilets and go before it becomes urgent to change their tampon or pad. Using a combination of tampons and pads on very heavy days is also common. Wearing dark trousers or skirts on heavy days also helps reduce the stress of worrying about leaks.
It can be easy to sometimes forget to take pads or tampons with you. It can then be a good idea to keep some at work or in your handbag. Women who soak through at night or are worried about this, often put an extra layer on the bed, like a waterproof sheet or simply a towel.
How is menorrhagia usually diagnosed?
Usually the amount of blood that is being lost is not measured exactly, because it is the problems associated with the period that are more important. If you go to the doctor to discuss menorrhagia, though, you will be asked to describe how heavy your periods are. One indication is how many sanitary pads or tampons you use per day during your period, so you might want to keep track of it for a month or two.
Because heavy periods are most commonly caused by benign growths in the womb, doctors will usually examine the womb. They palpate (feel) the womb and do 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 will show whether the heavy periods have led to anemia. If necessary, the doctor might do more tests, too.
Your personal situation and any symptoms you notice can give your doctor useful clues about possible causes too. That is why it is important for your doctor to know about any illnesses you have, illnesses that run in your family, medications you are taking, weight problems and whether you are under psychological stress.