Heavy periods

What counts as heavy

There is no single number. Doctors define heavy bleeding by its effect on you. Signs your periods are heavier than they should be include:

• Soaking through a pad or tampon every one to two hours for several hours
• Needing to use a pad and a tampon together, or waking at night to change
• Passing clots the size of a quarter or larger
• Bleeding for more than seven days
• Planning your life around your period, or missing work or school
• Feeling tired, weak, or short of breath, which can be signs of iron deficiency

Common causes

Heavy periods often have a structural cause, such as fibroids, adenomyosis, or polyps. They can also come from irregular ovulation, an inherited bleeding disorder, a copper IUD, or blood thinners. Less often, heavy bleeding is a sign of endometrial hyperplasia or cancer. That is more likely after age 45 or with risk factors such as obesity or polycystic ovary syndrome (PCOS). More than one cause can be present at once.

What evaluation usually involves

• A pregnancy test
• A complete blood count and ferritin to check for anemia and low iron stores
• A thyroid test, and sometimes other hormone tests
• A pelvic ultrasound to look for fibroids, polyps, or adenomyosis
• Testing for a bleeding disorder if your periods have been heavy since your first one, or you bleed easily in other ways
• An endometrial biopsy for some people, based on age and risk factors

Treatment

Many people get good control with medication alone, including non-hormonal options taken only during your period and hormonal options such as the levonorgestrel IUD. When medication is not enough or not the right fit, procedures range from removing a polyp to hysterectomy. Treating iron deficiency is part of the plan.