Heavy Menstrual Bleeding

About one third of women seek treatment for heavy menstrual bleeding. Though common, it is not normal and disrupts your life. It may also be a sign of a more serious health problem.
Menstrual bleeding can be considered heavy if any of the following criteria are met:
  • Bleeding that lasts more than 7 days.
  • Bleeding that soaks through one or more tampons or pads every hour for several hours in a row.
  • Needing to wear more than one pad at a time to control menstrual flow.
  • Needing to change pads or tampons during the night.
  • Menstrual flow with blood clots that are as big as a quarter or larger.
Heavy menstrual bleeding may signal an underlying health problem that requires treatment. Blood loss from heavy periods can lead to iron-deficiency anemia. In severe cases, anemia can increase the risk of heart problems.

Heavy menstrual bleeding can come from a variety of causes:
  • Fibroids and polyps
  • Adenomyosis
  • Irregular ovulation
  • Bleeding disorders
  • Medications (blood thinners or aspirin)
  • Cancer
  • Other causes (endometriosis, ectopic pregnancy, miscarriage or pelvic inflammatory disease) 
Treatment of heavy menstrual bleeding often begins with medications:
  • Heavy bleeding resulting from problems with ovulation, endometriosis, PCOS, and fibroids can be managed with certain hormonal birth control methods.
  • Hormone therapy can be used for heavy menstrual bleeding that occurs during perimenopause.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
If medication does not address the issue, surgery may be recommended:
  • Endometrial ablation (see Endometrial Ablation)
  • Uterine artery embolization
  • Myomectomy 
  • Hysteroscopy
  • Hysterectomy

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