Maybe your period feels like it goes on forever. Or maybe you’re relying on heavy-duty tampons or pads, doubling up on feminine products, or waking up in the middle of the night to change them. If any of these hold true for you, you may have menorrhagia, a condition defined by a cycle that lasts more than seven days or produces heavy bleeding.
We’ve been conditioned to think these symptoms are all normal, says Heather Irobunda, a board-certified OB-GYN with NYC Health + Hospitals. And it is true that heavy periods are common. According to research, up to 30 percent of women experience them.
But just because they’re prevalent doesn’t mean you should have to accept them. Substantial blood flow can change how you live, forcing you to stay home and avoid social events (you know, pre-COVID) on especially bad days. Worse, regular heavy bleeding can lead to anemia, Dr. Irobunda points out, a condition in which you lack healthy red blood cells to deliver oxygen to your organs. Anemia can place your brain and heart under chronic stress and potentially cause diminished mental and cardiovascular function over the long term. “Women think, ‘What harm is it doing?’ but over time and cumulatively, heavy bleeding is not good for your health,” she says.
All the more reason to find out what may be causing an overwhelming period—and what you can do about it. Here are seven common culprits.
These non-cancerous uterine growths are one of the most likely causes of heavy bleeding, Dr. Irobunda says. Fibroids have been found in 40 percent of women with severe menorrhagia.
Fibroids occur when a muscle cell goes rogue. By cloning itself and growing larger on the uterus wall, fibroids distort the uterine lining, making the uterus more likely to bleed and bleed heavily, Dr. Irobunda says. Fibroids can also interfere with the uterus’s ability to contract, which increases bleeding. The growths can be tiny or grow as large as a grapefruit. They also tend to accompany other symptoms, including a feeling of fullness in the pelvis, an enlarged abdomen, pain during sex, and frequent urination.
Fibroids are typically found among women in their 30s and 40s, and they tend to shrink after menopause, according to the Mayo Clinic. While researchers aren’t sure why, fibroids are more common among Black women. (This could be one reason why Black women tend to experience heavy bleeding at a higher rate than women of other races.) Genetics also influence your likelihood of fibroids; for example, says Dr. Irobunda, if your mother or sibling has fibroids, you may be more likely to have them too.
These smooth, finger-like, and typically non-cancerous growths are another common reason for heavy menstrual bleeding, says Dr. Irobunda. They can be caused by high estrogen levels, inflammation, or clogged cervical blood vessels, and they’re most commonly found in women over 40 who’ve had many children. The good news for eliminating heavy bleeding: If polyps are causing the problem, they can be removed, and they don’t often regrow.
This condition has a complicated name, but a straightforward explanation: The uterine walls enlarge and change in consistency, making heavier bleeding during periods more likely, Dr. Irobunda says.
Doctors aren’t sure what causes adenomyosis, but they do know that it’s generally found in women between the ages of 35 and 50 who’ve had at least one child, and one sign of the condition can be increasingly painful periods.
4. Your IUD
While hormonal IUDs can actually reduce or stop menstrual flow, copper-based IUDs, which people like because they’re hormone-free, can sometimes trigger longer, heavier cycles due to an inflammatory reaction that causes the uterine lining to bleed more, Dr. Irobunda says. According to the CDC, this may occur for the first three to six months after implantation.
5. A hormone-related problem
Hormonal imbalances can impact blood flow. For example, a hormone condition called polycystic ovulatory syndrome (PCOS) can cause heavy and irregular menstrual bleeding or fewer or irregular cycles.
Studies have also shown that perimenopausal women may suffer heavier periods due to hormonal irregularities.
6. A bleeding-related disorder
Women born with Von Willebrand disease (a bleeding disorder in which the blood does not clot properly) often have heavy periods.
Women who develop other bleeding disorders later in life (as a side effect of immune conditions, vaginal delivery, other medical issues, or certain medications) can also experience heavy periods, according to the National Heart, Lung, and Blood Institute. In these cases, heavy menstrual bleeding would be accompanied by symptoms like nosebleeds and easy bruising.
7. Cancer, rare conditions, and other causes
Research shows that endometrial cancer—a type of cancer that begins in the uterus and is mainly found in postmenopausal women—can be a possible cause of heavy menstrual bleeding.
Bleeding can also be associated with problems with the uterine lining, estrogen-modulating medications such as tamoxifen, and other conditions, such as an ectopic pregnancy.
WHAT YOU CAN DO
Make an appointment with your doctor or OB-GYN to find out why you’re experiencing heavy periods, and if any of the above descriptions feel applicable to you, let your physician know. To diagnose the problem, Dr. Irobunda typically does a pelvic exam and performs an ultrasound, and sometimes refers patients out for an MRI or bloodwork.
Even if a heavy flow simply keeps you couch-bound, you don’t have to be inconvenienced, Dr. Irobunda says. Insurance companies usually recognize heavy bleeding as a serious problem for quality of life and general health, she says, and often cover treatments and medications to help remedy the issue.
No matter the cause, there are many non-invasive, nonsurgical methods that can help address your heavy bleeding. Treatments include fairly simple remedies, such as iron supplements, birth control, hormone therapy, and prescription medication, or surgical options, such as removing polyps or fibroids. Together with your physician, you can find the best solution for you.