Why Are My Periods So Heavy?

Heavy periods are a common experience: Experts estimate that at least one in four (27%), and as many as one in two (54%), girls and women lose an excessive amount of blood during their monthly cycle. Menstrual flow is considered heavy if it lasts a week or longer, frequently includes large clots, or requires you to:

• Get fresh protection every hour (for several hours in a row)
• Wear two pads (or a pad and a tampon) to prevent leakage
• Change your protection one or more times during the night 
• Avoid usual activities to cope with period-related distress 

If heavy periods make you feel anxious, deplete your energy, cause you to miss work, or all of the above, schedule a visit at Panhandle Obstetrics and Gynecology. 

The first step toward period relief? Expert evaluation. Next steps depend on the cause of your heavy periods. In this month’s blog, our team takes a closer look at possible causes of heavy menstruation. 

Heavy menstrual period causes

It’s normal to experience a few heavy periods at times when female hormonal balance is in a state of adjustment, or flux. Menstrual flow is more likely to be heavy when periods first begin in adolescence, for example, as well as during the transition to menopause (perimenopause). 

When heavy menstrual bleeding happens consistently between these bookend events, however, a variety of potential factors may be at play, such as: 

Hormonal imbalances

A balance between the hormones estrogen and progesterone controls the buildup and shedding of the endometrium, or uterine lining. An imbalance with these hormones can lead to excess endometrial thickening that results in a heavy period when it sheds. 

Excess body weight, insulin resistance, an underactive thyroid (hypothyroidism), and polycystic ovary syndrome (PCOS) are common culprits behind hormone-related heavy periods. 

Uterine conditions

Benign growths (non-cancerous tumors) in your uterus, including polyps and fibroids, can lead to excessive bleeding in the form of heavy menstrual flow or long-lasting bleeding. 

Heavy periods may be a sign of adenomyosis, a condition that occurs when glands from your uterine lining (endometrium) grow into your uterine wall. They can also indicate endometriosis, a condition that causes endometrium-like tissue to grow outside your uterus. 

Pelvic infections

Heavy periods can be a symptom of a sexually transmitted infection (STI) like gonorrhea, chlamydia, trichomoniasis, or endometritis (infection-related inflammation of the uterine lining). Pelvic inflammatory disease (PID), an infection of the upper female reproductive tract, can develop on the heels of an STI and cause ongoing heavy periods. 

Certain medications 

Hormonal contraceptives like the pill can cause temporary changes in menstrual bleeding, including heavy periods and breakthrough bleeding (spotting between periods). The copper intrauterine device (IUD) is also associated with heavier periods during its first year of use.

Blood thinners and aspirin can make periods heavier and longer too. 

Cancerous growths

Heavy periods may be a symptom of endometrial hyperplasia, a precancerous condition that causes an excessive thickening of the uterine lining. Excessive bleeding can also be an early sign of endometrial, uterine, or cervical cancer — before or after menopause. 

Bleeding disorders

Bleeding disorders that stop your blood from clotting properly can lead to heavy menstrual periods. Some bleeding disorders are genetic (inherited), like Von Willebrand disease, while others are acquired, or triggered by factors like autoimmune disorders or infection. 

Evaluation, diagnosis, and care 

Given that there are so many possible causes of heavy periods, any investigation must be thorough to reach an accurate diagnosis. After discussing your menstrual cycle history, previous pregnancies, contraception use, prior illnesses or infections, and overall medical history, we perform a physical exam, including a pelvic exam. 

Depending on our initial findings, we may order:

• Blood tests to check for anemia, hormonal imbalances, and clotting issues
• Ultrasound imaging to visualize your uterus and other pelvic organs
• A Pap test or cervical culture to look for cancer, infection, or inflammation
• An endometrial biopsy to check for abnormal cells in your uterine lining

Heavy periods may resolve on their own if they’re caused by a mild hormonal fluctuation; when they’re related to excess weight, shedding a few pounds can help. 

In most cases, we recommend medications to make your periods lighter. The medication that best matches your needs depends on your life stage as well as the underlying cause of the problem; hormonal contraception often works well for PCOS-related heavy periods, while hormone therapy can be a good option for heavy periods during perimenopause. 

Heavy menstruation that doesn’t respond to medication — or is related to cancer — may require surgical intervention, such as minimally invasive fibroid removal (myomectomy) or a hysterectomy. 

Specialist care for heavy periods 

Heavy periods aren’t the norm, and we can help you get to the bottom of the problem. Call 806-359-5468 to schedule an appointment at Panhandle Obstetrics and Gynecology in Amarillo, Texas, today.