What Is Menorrhagia?
Menorrhagia is the medical term for unusually heavy or long menstrual periods. Many women and people assigned female at birth (AFAB) have heavy flow days, and cramps are common during their period. But about 1 in 5 women deal with menorrhagia, or very heavy menstrual bleeding or bleeding for a full 7 days.
With menorrhagia, your flow may be so heavy that you’ll need to change your tampon or pad every hour for at least an entire day. You also might have cramps so severe that they stop you from doing your usual activities.
Heavy periods can be caused by uterine or hormonal problems, or other conditions like bleeding disorders or cancer. If you soak through a pad or tampon every hour or so on a regular basis, talk with your doctor. They may be able to help.
It is pretty common to have irregular menstrual cycles during puberty -- where your period is light one month and heavier the next. But adolescents don't usually have periods that are heavy enough to be considered menorrhagia. If you do, you should talk to your doctor to find out what could be causing such heavy periods.
Your doctor will usually talk with you about your medical history, menstrual cycle, medications you take, sexual history, and if you've had any pregnancies. Your doctor may also have you track your periods including how often you have them and the number of days you have heavy bleeding.
You'll have a physical examination and a pelvic exam (where the doctor examines your internal reproductive organs) if the doctor thinks one is necessary. Your doctor may also order blood tests and an ultrasound, a test that uses sound waves to make images of internal organs.
For most adolescents, surgery isn't required to treat heavy period bleeding. Your doctor will usually prescribe a nonsteroidal anti-inflammatory drug (NSAID), like ibuprofen, to help with pain and reduce bleeding. They may also prescribe contraceptives, hormones, or tranexamic acid, which reduces blood loss during your period.
You may have had heavy periods from your first menstrual flow, or you may just be getting heavy menstrual bleeding after decades of typical periods.
It’s always a good idea to talk with your doctor about your heavy periods, especially if the problem is new for you. It could lead to anemia (low levels of red blood cells), which can make you feel weak, tired, or out of breath.
If you have menorrhagia, you may have to:
- Change pads or tampons at least once an hour for a day or more
- Change pads in the middle of the night
- Wear two pads at a time to manage heavy flow
You may also:
Common causes of heavy periods include:
- Hormone problems. Every month, a lining builds up inside your uterus (your womb), which you shed during your period. If your hormone levels aren’t balanced, your body can make the lining too thick, which leads to heavy bleeding when you shed the thicker lining. If you don’t ovulate (release an egg from an ovary), this can throw off the hormone balance in your body, too, leading to a thicker lining and a heavier period.
- Growths in the uterus (womb). Polyps are growths within the lining of your uterus. Fibroids are benign (noncancerous) tumors that grow within your uterus during childbearing years. Both can make your periods much heavier or last longer than they should.
- Certain intrauterine devices. Many women use a small intrauterine device (IUD) for birth control. If your IUD doesn’t have hormones, it may make your periods heavier.
- Problems related to pregnancy. In rare cases, after sperm and egg meet, the growing ball of cells implants itself outside the uterus instead of inside. This is called an ectopic pregnancy. It can’t be a viable pregnancy, and it may cause serious health problems, such as heavy bleeding, which you may mistake for a heavy period. A miscarriage, which is when a baby dies in the womb, can also be the cause of heavy bleeding.
- Some female cancers. Rarely, cancer of the uterus, cervix, or ovaries may cause excess bleeding, which may appear to be a heavy period.
- Bleeding disorders. They’re not common, but bleeding disorders like Willebrand's disease -- which run in families -- make it hard for someone to stop bleeding when they’ve been cut. They can also make your period heavier and last longer.
- Adenomyosis. This happens when the glands in the uterus lining grow into the uterus wall, causing painful periods and heavy bleeding.
- Certain medications. Blood thinners like apixaban and warfarin; drugs that fight inflammation like NSAIDs; and some hormonal medications, like birth control pills, can cause heavy periods.
- Other health problems including:
To determine if you have menorrhagia, your doctor will ask about your health history and ask you to describe your symptoms. They may also have you start a diary that tracks the length of your periods, how heavy the bleeding is, and days with and without bleeding.
They’ll do a physical exam and may need to order tests, including:
- An ultrasound , which creates pictures of your uterus and other internal organs
- A Pap test, which uses cells from your cervix to check for inflammation, precancerous changes, and human papilloma virus (if you are over the age of 25)
- Blood tests to check for anemia, thyroid disease, and blood-clotting conditions
- Biopsy, which uses tissues from your uterus to show cancerous or precancerous cells
- Pelvic exam, which lets the doctor check for growths like fibroids or tumors
Menorrhagia versus metrorrhagia
Menorrhagia is very heavy bleeding or longer periods. Metrorrhagia is very heavy bleeding outside of your regular menstrual cycle (light spotting between periods is relatively common during puberty, and sometimes even later in life). You may also have a combination of the two -- heavy periods and bleeding in between. This is known as menometrorrhagia.
Medication is usually the first type of treatment your doctor will prescribe to reduce heavy menstrual bleeding. These include:
- Hormonal drugs. Taking birth control pills or progesterone can alter the balance of hormones in your body, which can put an end to heavy periods.
- IUDs. Some give off hormones that may help lighten your periods.
- Anti-inflammatories. NSAIDs or naproxen sodium can reduce cramping and the amount of blood you lose during your period.
- Antifibrinolytics. Tranexamic acid can be taken during your period to lighten blood loss. This medication stops enzymes that dissolve clots in the lining of the uterus.
- Gonadotropin-releasing hormone agonists and antagonists. Also known as GnRH medications, these help reduce bleeding during your period. Elagolix and Relugolix can be used alone or with hormones to reduce bleeding caused by fibroids and endometriosis.
If your menstrual flow is still painful or the heavy bleeding is interrupting your lifestyle after trying medication, your doctor may recommend one of several kinds of medical procedures.
- Ultrasound. Your doctor may be able to target and shrink fibroids by using ultrasound waves.
- Uterine artery embolization. With this procedure, your doctor will put a catheter in an artery in your leg. Through the catheter, they inject tiny beads that block the blood flow to, and shrink, fibroids.
- Surgery. If your doctor finds polyps or fibroids, you can have them shrunk or removed. This may stop the heavy bleeding.
- Dilation and curettage (D&C). During a D&C, your doctor will open, or dilate, your cervix. Then, they will suction or scrape some of the tissue from the outermost layer of the lining of your uterus. The procedure often stops heavy periods, but some women need to get this done more than once. A D&C may also be used to tell your doctor what is causing your heavy periods.
- Other procedures such as endometrial ablation and endometrial resection permanently remove or destroy the lining of the uterus. Women have much lighter periods or no periods afterward. Doctors advise women not to get pregnant after endometrial ablation or resection. You’ll still need to use birth control because these treatments aren’t a form of contraception.
- Hysterectomy. In severe cases, you may need this surgery, which will remove your uterus. You won’t have your period anymore, but you also won’t be able to get pregnant.
The bleeding of menorrhagia can lead to other problems including:
If you have complications, talk to your doctor about what might help control your menorrhagia and related symptoms.
Is menorrhagia dangerous?
Menorrhagia isn't typically a dangerous condition. Some conditions that cause heavy menstrual bleeding -- like endometriosis, uterine fibroids, and PCOS -- can make it harder to get pregnant. If one of these conditions is causing menorrhagia and you want to get pregnant, talk to your doctor about treatment options.
Natural Remedies for Heavy Periods
At-home treatments don't replace medical care from your doctor. But there are some things you can do that may ease your pain and reduce heavy bleeding during menstruation.
Water. Drinking plenty of water will help keep your blood volume up, which can drop if you are having a very heavy period.
Iron. Eating foods with lots of iron can help reduce the chance of anemia. You can include beans, leafy greens like spinach, oysters, lentils, and fortified cereal in your diet.
Herbal teas. Ones thought to help regulate hormones and reduce inflammation of the uterus include raspberry leaf, cinnamon, ginger, and licorice.
Hot or cold packs. Hot packs can help ease cramps, and an ice pack may reduce heavy blood flow.
Vitamin C. Foods full of vitamin C may strengthen blood vessels and help absorb iron. Some good options are strawberries, tomatoes, citrus fruits, and bell peppers.
Menorrhagia, or heavy menstrual bleeding, isn't a dangerous condition, but it can disrupt your life. It can also cause anemia, which can make you feel weak and fatigued and may make getting pregnant difficult. Some home remedies like herbal tea, hot pads, and a healthy diet can reduce symptoms. But treatment by a doctor may be required to reduce your menstrual flow and relieve cramps.
- What foods should you avoid with menorrhagia? There aren't a lot of foods that impact heavy menstrual bleeding, but you may want to avoid alcohol, which can be dehydrating; spicy foods (if they make you sick to your stomach, that could just make you feel worse if you have cramps); and red meat, though it does have iron, also has prostaglandins, which can increase cramps.
- How common is menorrhagia? About 1 in every 5 women have periods heavy enough to seek treatment from their doctor.
- How long is too long for menorrhagia? Talk with your doctor if you have a heavy period that lasts longer than 7 days.