Heavy Menstrual Bleeding: What's 'Normal,' Treatment Options, and More
Every woman’s period is different, some lasting only a few days with a light flow, others lasting a week with a heavier flow, and everywhere in between. But you likely have a relatively similar flow each month. In some cases, it can hard to know whether you have what is considered to be heavy menstrual bleeding, also called menorrhagia. How do you know how much is too much?
What is a typical period?
During a typical period, a woman loses approximately 60 milliliters of blood, which is enough to fill about one and one-half shot glasses, according to the U.S. National Library of Medicine. Your periods may be a little lighter or heavier than this. To be considered menorrhagia, doctors look for blood loss of about 80 milliliters or more.
How to determine whether your period is too heavy
Because we don’t have a practical way of actually measuring our blood flow, it can be hard to know whether your period is “typical.”
However, there are signs you can watch for. For example, you can somewhat measure your flow by how many and how often you change your tampon, pad, or menstrual cup. According to the American Academy of Family Physicians, you may have menorrhagia if you:
- need to change your tampon or pad hourly or need to use a tampon and a pad together for more than a few hours
you notice large or heavy clots
have periods that last for more than one week
are excessively tired or lethargic during your period, which can be a sign of anemia from blood loss
find your amount of bleeding or pain from cramping interferes with your daily life or causes you to miss school or work
Younger girls frequently have irregular bleeding in the first few years after menstruation begins, according to a report published in 2008. This might make it difficult to determine if “heavy” bleeding occurs; however, the general rule of thumb is that if you need to change protection more than once per hour or wake up several times per night to change protection, you should be evaluated by a doctor.
What to do if you have heavy periods
There are several steps you can take if you think you have heavy periods:
You may want to start by keeping a log of your menstrual flow for a few months. Keep track of how often you change your tampon or pad, how many you use during your period and how long it lasts.
Write down whether you have cramps and how many days the cramps or other symptoms, such as headaches, lasts.
Once you have tracked for a few months, make an appointment with your gynecologist, who may request a blood test to check your hormonal and iron levels. In addition, you will probably have a pelvic examination. Your doctor will look for underlying conditions which may be causing your heavy periods, such as uterine fibroids, endometriosis, pelvic inflammatory disease (PID), and polyps on the lining of the womb.
Treatment for menorrhagia
While treatment for menorrhagia is often not medically necessary, many women do want treatment to help alleviate the discomfort and the pain from cramping.
According to Johns Hopkins Medicine, some of the common treatments include:
Birth control pills to help regulate hormones
Anti-inflammatory drugs, which can reduce flow by approximately one-third
Ablation, which is a procedure to destroy the lining of the uterus, or resection, which removes the lining of the uterus
A hormonal IUD, which often reduces menstrual flow and cramping
For extreme cases, surgical options include using laser or heat treatments to destroy the lining of the uterus or a complete hysterectomy (removal of the uterus) can be performed.
In addition to treatments specifically for heavy bleeding, you may need to be treated for secondary problems, such as being given iron supplements for anemia.
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