Heavy periods or Menorrhagia: Causes, Diagnosis and Treatment

Updated: June 16, 2022

When a women lose an excessive amount of blood during their period that is known as heavy periods. It can sometimes happen along with other symptoms, such as period pain.
Heavy bleeding doesn't always associated with serious health problems, but it can affect a woman physically and emotionally, and disrupt everyday life.

How much is heavy bleeding?

The amount of blood lost during a period varies from woman to woman. So it is difficult to define exactly what a heavy period is. Usually the average amount of blood lost during a period is 30 to 40 ml. 60ml or more blood loss in each cycle is considered as heavy menstrual bleeding.
If you are using an unusually high number of tampons or pads, that is an indication that your blood loss is excessive.

Causes of heavy periods:

There are several conditions that can cause heavy periods which include:

Polycystic ovary syndrome (PCOS):

In this condition tiny cysts are formed on ovaries which interfers with regular ovulation.  PCOS is a major cause of infertility and can increase the risk of diabetes and heart disease.

Pelvic inflammatory disease (PID):

This is an infection in the upper genital tract, may be in the womb, fallopian tubes or ovaries that can cause pelvic or abdominal pain and bleeding after sex or between periods.

Adenomyosis :

When tissue from the womb lining becomes embedded in the wall of the womb, that can cause heavy bleeding.

Endometriosis:

When small pieces of the womb lining are found outside the womb, such as in the fallopian tubes, ovaries, bladder or vagina can cause heavy bleeding.

Fibroids:

Non-cancerous growths that develop in or around the womb and can cause heavy or painful periods

Cervical or endometrial polyps:

Non-cancerous growths in the lining of the womb or cervix can cause heavy bleeding.

Hypothyroidism:

An underactive thyroid gland doesn't produce enough hormones, causing tiredness, weight gain and depression.

Blood clotting disorders:

Von Willebrand disease is a disease where blood cells stick together (clot) when you bleed causing heavy bleeding.

Womb Cancer:

Heavy or painful periods can be due to cancer of the womb.
Some medical treatments that can cause heavy periods include:

• anticoagulant medication taken to prevent blood clots
• an IUD (intrauterine contraceptive device) can make your periods heavier for the first three to six months after insertion 
• some medicines used for chemotherapy

Diagnosis of heavy periods:

Diagnosis is usually done by a pelvic examination. Sometimes a blood test may also be recommended to check for iron deficiency (anemia). You may need to have an ultrasound scan if an underlying cause of your heavy periods isn't found.

Treatment of heavy periods:

Treatment of heavy period is not required if there is no serious cause behind it, or the bleeding doesn't affect your everyday life. If treatment is necessary, medication is usually preferred first. The aim is to:

•     reduce or stop excessive menstrual bleeding
•     treat or prevent iron deficiency anemia caused by heavy bleeding

Contraception pills and Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to treat heavy periods.
If medication isn't effective in treating your heavy periods, surgery is suggested.
If the cause is fibroids, you may be recommended either:

•     uterine artery embolization
•     myomectomy

If your heavy periods aren't caused by fibroids, your options include:

•     endometrial ablation, where the womb lining is destroyed
•     hysterectomy, where surgical removal of the womb is done