So, you think you have heavy periods?

October 7, 2011 at 3:34 am 33 comments

Whenever I ask a patient “do you have heavy periods?”  I feel like I deserve the kinds of answers I receive.  I’m just as likely to hear “Yes.  I have to change a panty liner every few hours.” As to hear, “No.  I only go through one box of super-overnight maxi-pads per day now.  It used to be two boxes.”  Which is to say that every woman perceives whether or not her periods are heavy through the filter of her own personal experience.  

So, what exactly is a heavy period?  Well, the standard definition is a period that lasts longer than 7 days or in which a woman loses more than 80 millileters of blood.   The first definition is easy.  You just count the days on a calendar.  The second is much more difficult to determine.  (Unless you go wringing your sanitary products into graduated cylinder flasks.  In which case, maybe you need a psychiatrist, not a gynecologist.) 

So, how is the average woman to know what constitutes a truly heavy period?  If you’re saturating your pad or tampon every hour, it’s a good bet your period is heavier than average.  Similarly, if you tend to bleed through your tampon, onto your pad, and soak your pants, you probably need to see a doctor (and a good dry cleaner).  

There are lots of reasons why women get heavy periods.  The medical term for them is menorrhagia. Heavy menses aren’t just an inconvenience.  They’re a real medical problem which can result in anemia (a reduced blood count) and fatigue.  They can also be a sign of other serious medical conditions. 

Adolescents and teens may have heavy, irregular periods as they begin to establish their menstrual cycle.  These natural fluctuations in the menstrual cycle are often temporary, and usually resolve when monthly menses begin over the next few months to years.  Adolescents and teens with very heavy menses, or whose cycles do not become lighter on their own, may need to be evaluated for bleeding disorders, such as von Willebrand disease.

Women in their reproductive years may have heavy menses or irregular cycles because of hormonal conditions, such as polycystic ovarian syndrome (PCOS), which can cause irregular menses and heavy menstrual bleeding on the rare occasions when menses take place.  Another hormonal condition which can case heavy menses is an underactive thyroid gland (hypothyroidism).  Both of these conditions can cause excess weight gain.  Being overweight (even in the absence of other medical conditions) can worsen heavy menstruation.  This is because adipose (fat) tissue produces excess estrogen, thickening the lining of the uterus.  When the lining is shed at the end of the menstrual cycle, heavier bleeding occurs.

Hormonal conditions may be suspected on the basis of a physical exam, history, blood tests, ultrasound (sonogram) or a combination thereof.  A combination of medication and dietary and/or lifestyle changes may be helpful in regulating the menstrual cycle and reducing bleeding.

Certain medications can lead to heavy menses.  Blood thinners (Coumadin, Lovenox) and Non-steroidal anti-inflammatory medications (Motrin, Advil, Ibuprofen and Aspirin) can increase menstrual bleeding.  Missed doses of oral contraceptives can also lead to heavy menses or irregular cycles.

Some women have heavy menses due to abnormalities of the uterus and its lining.  An endometrial polyp is a growth of tissue in the lining of the uterus.  Because polyps have a rich blood supply, they can cause heavy bleeding either during or between menses.  Uterine fibroids can also cause heavy menses.  Fibroids are benign muscle tumors which can impinge on the lining of the uterus, causing heavy menstrual bleeding.  They can also cause other symptoms (such as pain, pelvic pressure, frequent urination, miscarriage) which likewise bring them to a doctor’s attention.  Both endometrial polyps and uterine fibroids are readily diagnosed by an ultrasound (sonogram).  Bleeding due to polyps and fibroids can often be managed with the use of minimally invasive surgical techniques (such as hysteroscopy and laparoscopy).

The most serious cause of heavy menstrual bleeding, especially in women who resume menstrual-like bleeding after the cessation of normal periods (menopause), is endometrial cancer.  This type of cancer is rare in women under the age of 35 and is much more common after menopuause.  Endometrial cancer may be suspected on the basis of an ultrasound (sonogram).  It can be diagnosed by a biopsy or by a surgical procedure called a dilatation and curettage (D and C).  Endometrial cancer is often responsive to treatment when caught early.  

In summary, heavy menses are very common.  They may represent a normal variation in a healthy woman’s cycle, or they may be due to a medical condition which requires treatment.  Attention from a skilled healthcare provider can help determine whether additional care is needed.

A Good Resource:

ACOG Guide to Abnormal Uterine Bleeding

One Last Cartoon:

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Entry filed under: Gynecology, Minimally Invasive Surgery. Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , .

Before Baby 2011 in review

33 Comments Add your own

  • 1. saousad  |  October 18, 2012 at 11:03 am

    Colud you please telle us more about endometrial ablation techniques?
    How you select patients, technology to use and setting of the procedure

    Reply
    • 2. drnicoll  |  November 11, 2012 at 11:25 pm

      Hi Saousad,
      Will do. I’ll write a new post about this topic soon!
      -Dr N

      Reply
      • 3. saousad  |  November 11, 2012 at 11:29 pm

        Thanks!

  • 4. Mindi  |  December 1, 2012 at 6:57 pm

    I contacted my dr r/t my period of10 days with clots as you described soaking tampon onto pad and pants within 1 hr this is only my second period in 16 months since having my daughter and tubal ligation I am fatigued and feel horrible

    Reply
    • 5. drnicoll  |  December 1, 2012 at 7:49 pm

      Hi Mindi,
      I don’t dispense individual medical advice on this site. If you are experiencing heavy bleeding and other associated symptoms, you should seek immediate medical attention. If you have already contacted your gynecologist and do not feel you have gotten appropriate attention, please seek out another women’s healthcare provider for a second opinion or speak with your primary care physician. Use of a hospital emergency room or the 911 emergency response system is always appropriate in case of an emergency.
      Best of luck,
      Dr. N

      Reply
  • 6. heather  |  January 12, 2013 at 7:51 pm

    I had my mire a put in on December 21, 2012. I’ve been bleeding and cramping ever since. Some days I bleed so much I bleed through a tampon and onto the panty liner in an hour. Is that normal?

    Reply
    • 7. drnicoll  |  February 5, 2013 at 4:11 am

      Hi Heather,
      I don’t dispense individual advice on this blog. That being said, excessive bleeding might be defined as soaking one sanitary pad every one or two hours. Excessive bleeding after Mirena insertion is unusual, and requires immediate medical attention. Milder bleeding, similar to a period, is more common and usually resolves over a few weeks. Any concerns about whether your bleeding is normal or not should be brought to your doctor’s attention. An exam can confirm whether the iud is in the right locaation. A discussion can clarify whether it should be kept in place or removed.
      Best of luck,
      Dr N

      Reply
  • 8. Cathy  |  February 5, 2013 at 1:26 am

    Wow, what a well-written, super-informative blog post! The accompanying pics are hilarious. I just stumbled here after googling ‘uterine polyps weight gain’. I had a hysteroscopy/polypectomy/D&C one week ago, which went swimmingly & post-procedure, wondered if I might enjoy some free weight loss. Alas, no. I will have to continue putting all my eggs into the diet/exercise basket.

    Reply
  • 9. Bethann Renee Handshoe  |  April 17, 2013 at 8:19 am

    I had a ablastion one year ago for heavy bleeding and then a few weeks ago ended up pid and they found a polyp on the ultrasound and have been having extreme pain for weeks and now am bleeding through a tampon every hour but can not get any dr. to do anything about it cuz I have no ins. so a suggestions?

    Reply
    • 10. drnicoll  |  April 17, 2013 at 5:03 pm

      Hi Bethann,
      I do not provide individual medical advice on my blog. Emergency medical attention is available through hospital emergency rooms regardless of insurance status. Most emergency rooms and hospital clinics (whose direct contact information can usually be found by calling the hospital’s general phone number) have services for uninsured patient. These places, which are set up to care for the uninsured, usually provide access to social workers and financial specialists whose job is to see that out-of-pocket costs to patients are as low as possible.
      Best of luck,
      Dr. N

      Reply
  • 11. Douglas  |  April 19, 2013 at 4:05 pm

    Hello! I know this is kinda off topic but I’d figured I’d
    ask. Would you be interested in exchanging links or maybe guest
    writing a blog article or vice-versa? My website discusses a lot of the same topics as yours and I feel we could greatly benefit from each other.
    If you are interested feel free to send me an email.
    I look forward to hearing from you! Terrific blog by the way!

    Reply
    • 12. drnicoll  |  April 24, 2013 at 10:58 pm

      Hi Douglas,
      That sounds good. And thanks for the compliment.
      I am happy to write a new entry for your blog (and will share it and a link to your site on mine). Would you like to suggest a topic?
      As for your guest post on mine, what would you like to write about?
      -Dr N
      P.S. I tried the freenet.de email address and it bounced back. I’d be happy to continue our exchange privately by email.

      Reply
  • 13. alina  |  November 6, 2013 at 5:56 pm

    Hello, I know you said that you do not individual medical advice but I cant call any doctor because im scared and I Don’t know what a gynecologist will do….. ive been having some faint yellow discharge coming from (you know where) and I just NEED to know if that’s normal or not plus I REALLY need this by today!

    Reply
    • 14. drnicoll  |  January 26, 2014 at 3:21 am

      Dear Alina,
      Writing to a doctor on a blog and asking for advice may seem like a good idea, but it never is. A good doctor will take the time to listen to your symptoms, will guide you through an exam in person, and will discern what’s normal and what requires treatment (by prescription or otherwise). Taking a short-cut and seeking to self-diagnose on the internet or asking a doctor on a blog for treatment is a great way to misdiagnose and mistreat problems. Go see a doctor. Seeing a real, live doctor who can take time with your concerns is certainly less scary than what you can find on the internet.
      Best of luck,
      Dr. N

      Reply
  • 15. Becky  |  January 24, 2014 at 11:06 pm

    A search on heavy menses led me to your blog. I am so grateful for the information you’ve provided. A recent knee injury forced me to take quite a bit of ibuprofen and it just happened that it was a forgetful birth control couple of weeks. (I’ve been using other protection.) my work day ended with two enormous maxi pads in three hours. Oy. The sense of humor and information you provided lightened my mood considerably. I will see a doctor if it continues but now I can relax a little this evening and “ride it out” as it were!

    Reply
  • 16. Jessica  |  August 7, 2014 at 9:10 pm

    Hi I started spotting on the 28th of July it did stop and start every other day I was spotting. now as of yesterday 8-6-14 and today I have had to change my tampon and pad 3 times an hour and I am scared that it may be cervical cancer because they are checking me every 6 months for it.. can excessive bleeding be a symptom of cervical cancer?

    Reply
    • 17. drnicoll  |  February 20, 2015 at 7:40 pm

      Hi Jessica,
      As I have written many times before on this site, I do not give out individual medical advice on this blog. Please contact your doctor ASAP.
      Best regards,
      Dr N

      Reply
  • 18. blood in uterus  |  August 28, 2014 at 7:44 pm

    Very great post. I just stumbled upon your blog and wished
    to say that I’ve truly enjoyed surfing around your blog posts.
    In any case I will be subscribing in your rss feed
    and I hope you write once more very soon!

    Reply
  • 19. Rosie  |  September 6, 2014 at 6:34 pm

    Hi, I’m quite worried because, I just came on my period yesterday evening, it was quite light, I slept with a regular tampon in, no leakages. It gradually got heavier in the day, I then put in a super plus extra tampon (the highest absorbency) and it got filled within an hour, I’m so sick of this, I’ve had to change several times today, I’m 15, do I need to see the doctor? this also happened at christmas!

    Reply
    • 20. drnicoll  |  February 20, 2015 at 7:39 pm

      Hi Rosie,
      As I have written many times before on this site, I do not give out individual medical advice on this blog. Please contact your doctor ASAP.
      Best regards,
      Dr N

      Reply
  • 21. helina  |  September 7, 2014 at 8:32 pm

    Pls what causes such sickness nd how do we treat it

    Reply
    • 22. drnicoll  |  February 20, 2015 at 7:39 pm

      Hi Helina,
      As I have written many times before on this site, I do not give out individual medical advice on this blog. Please contact your doctor ASAP.
      Best regards,
      Dr N

      Reply
  • 23. brittany  |  February 2, 2015 at 1:59 pm

    I had an emergency csection.on dec 22 2014 an barely bleeding. A few days ago i started bleeding where im going through a tampon and a pad every couplr hours. At night when im sleeping i always wake up in the mornings an sheets are bloody an my underware are stained. What should i do.

    Reply
    • 24. drnicoll  |  February 20, 2015 at 6:31 pm

      Hi Brittany,
      I don’t give out individual medical advice on this blog. Please call your doctor ASAP.
      Best regards,
      Dr. N

      Reply
  • 25. qelle  |  March 16, 2015 at 2:32 am

    Dr Nicholl,
    I think your blog is fantastic! I have spent most of my career assisting OB/GYN Doctors and I try to help with that knowledge in an IRC (internet relay chat) channel focused on sex and relationships. I ask them questions and in turn remind them of things they may not otherwise tell their doctor.
    I think your responses to comments here are worded in a way that people “get it” and I was hoping that you would be okay with me quoting your blog in the future. i.e. “Seeing a real, live doctor who can take time with your concerns is certainly less scary than what you can find on the internet.”
    Thank you for being awesome and addressing issues with real answers…….
    I will now go change my tampon for the 6th time today and be a good patient and make an appointment. 🙂

    But really, I would love to link to your blog!

    Reply
    • 26. drnicoll  |  August 26, 2015 at 6:27 pm

      Thanks, Qelle.
      Please feel free to share my blog with anyone and everyone. Links to this site are always appreciated.
      Thank you as well for the kind words.
      -Dr Nicoll

      Reply
  • 27. Elaine  |  March 25, 2015 at 2:24 pm

    Just reading up on some women’s health issues and came across this site. I think what you’ve written is very well described. Although I never noticed my periods as irregular, but I was diagnosed with a teratoma on both my ovaries. After having them removed in my mid twenties I am always on the look out for symptoms. I think what you’ve described to other women on here is great and I hope other women seek professional medical advice if they do have these symptoms. I know if I was more alert with my body, I would have had medical procedures before it was unsaveable. I know it was just bad luck to get two teratomas but I am lucky to be alive. I just hope more women out there are aware of their bodies.

    Reply
  • 28. lyn roberts  |  June 12, 2015 at 10:17 am

    I have had Endometrial Cancer at 51, diagnosed after hemorrhage, 3 units of blood later, presented emergency dept, asked to sit in chairs and wait, Dr walked past, took one look at me and said don’t move, went and got wheechair and much to others in chairs, wheeled me through to clinical area, asking was I dizzy, yes, and was I breathless, yes. D & C and discharged, panic stricken phone call from hospital 24 hours later, can you come back tommorrow, have made appt fro you to see doctor immediately, 2 weeks later pelvic clearance, they forgot to tell me about traumatic change of life, that was not fun. Five years later, sister 5 years younger, rang me, she had also had hemorrhage, what had happened to me,? I repeated and told her to watch out for traumatic change of life, withdrawl of all oestrogen. She later asked me did I remember Mum’s sudden hospital trip, yes but didn’t know much about it. She was able to FOI Mums file, guess what same problem, so my mother, my sister, and now my daughter is also having problems, fobbed off by doctor is entirely unacceptable with our family history I believe. Don’t worry I will be talking to my Doctor, and getting him to ring daughters doctor to give him a kick in the bum.

    Reply
    • 29. drnicoll  |  October 2, 2015 at 4:45 pm

      HI Lyn,
      As I have said numerous times on this blog, I do not dispense individual medical advice on this site. Please call your doctor or see a physician at an emergency room/urgent care.
      Best regards,
      Dr N

      Reply
  • 30. Lindsey  |  August 26, 2015 at 7:18 am

    Very interesting to read. I think what brings us readers here are experiences with this, and I love the humor used while relaying info. Id make a joke and ask a personal medical question, each time you responded to one on the comments, it got shorter,but still nice nust frustrated, but i think I’ll hold off. I wish my own experiences with doctors had a fraction of your humor, which i have a feeling translates into a great doctor patient rapport!
    Just curious, do you think the taboo of talking about periods is getting better/worse? I think it’s interesting that a blog, or looking to this medium is easier than admitting to family about a problem or going to the doctor about a period for fear of being the ‘hysterical’ woman.

    Reply
    • 31. drnicoll  |  August 26, 2015 at 6:24 pm

      Hi Lindsey,
      I don’t think anyone likes repeating him or herself. It makes one feel like he or she isn’t being heard in the first (or second, or third!) place. So, if my replies get shorter when I repeat myself, I hope I can be forgiven 🙂
      I think the taboo of talking about periods has somewhat lessened among women. Certainly the profusion of blogs, memes, threads and other electronic discussion forums devoted to the topic has exploded as the internet has facilitated the sharing of personal and medical information. With greater discusion and exposure, the taboo lessens. However, as a society, we tend to view menstruation in a negative light which has historical, cultural, religious and family contexts that won’t be washed away by a generation or two of liberated ladies promoting period power. (I swear, I heard the words ‘period power’ in a commercial for MetroPCS and almost died laughing. Pity the PR people who came up with that one. The American Apparel ‘period power’ shirt isn’t much better, but at least it’s intentional.) The term, ‘hysterical’, as you probably know, also has deep roots in medical misogyny. So the hesitation to trust a doctor with one’s problems isn’t unfounded. I just hope that today’s women feel empowered to choose a health care provider (of either gender) who is sensitive to these issues and with whom they feel comofortable speaking about any variety of gynecologic topics. If not, it may be time to reexamine our own preconceived notions about what makes this topic ‘taboo’ for ourselves.
      -Dr N

      Reply
  • 32. Susan  |  September 3, 2016 at 4:38 pm

    I suggest when physicians ask patients about their cycles to ask how many (and what type, size) of me stu real products are used. I am a patient, not a physician. I didn’t realize that 9-10 super plus tampons and soaking through an overnight pad on a heavy day might be a lot.

    After I had a laproscopic tubal ligation, my OB/GYN shared photos of my uterus where endometrial tissue was growing. I found out Ihad endometriosis. He cauterized the tissue and I didn’t realize that the pain I was having during my cycle was partly exacerbated by it. A few months of less painful cycles was pleasant.

    Due to mid-cycle spotting for over a year, my PCP sent me to an OB/GYN and I had an endometrial biopsy and an ultrasound. Fibroids were discovered.

    I’m 51 and no signs of slowing down in my cycle. None of my physicians asked how many or what kind of feminine products I was using, nor the quantity. After reading about fibroids, I shared with my female PCP that I didn’t realize that my use of products might indicate a heavy cycle. She then asked and was surprised.

    Perhaps that needs to be an area addressed in medical school education. More women may find help sooner rather than later. They may also get some empathy from their physicians. I’ve had friends who’ve had their complaints of heavy cycles dissed until blurting out how many products they were using. And then, some physicians still rolled their eyes.

    Reply
    • 33. drnicoll  |  September 8, 2016 at 2:44 pm

      Hi Susan,
      As a physician educator who is actively involved in medical student teaching, I totally agree with you. I do teach medical students and young physicians who are still in training to ask patients to quantify things that can seem subjective at first. Measuring the heaviness of a period by asking how many (and what type of) sanitary products are used and measuring a patient’s pain by asking about medication use (over the counter and prescription) and how it affects activities (like missing work, school, or exercise) is indeed very helpful and is a skill which can be easily taught and learned.
      I do think it’s a mistake to assume that physicians of one gender or another would be better or worse at a particular specialty (or more comfortable talking about periods just because they have personally experienced a menstrual cycle). I have seen great sensitivity (and, sadly, insensitivity) among physicians across age, gender, specialty and other demographic lines.
      I think that patients should focus on finding a gynecologic health provider who is empathetic, a good listener, and who gives good advice. If a patient isn’t getting that from her current provider, changing doctors or practices may be the next step. As for me, my work as an educator of the next generation of physicians (of all genders and gender identities) gives me great hope for the future of medicine in their hands.
      Best regards,
      Dr N

      Reply

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Linda M. Nicoll, MD

Welcome to my blog! Here you will find information about minimally invasive gynecologic surgery as well as some more general information about common gynecologic disorders such as endometriosis, ovarian cysts, fibroids, infertility, and pelvic pain.

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