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Heavy periods and menorrhagia

Far from pleasant—this is how most women would describe their periods—even though menstruation is a completely normal, natural, and more or less regular process. However, menorrhagic menstruation is abnormally heavy bleeding often accompanied by severe cramps.

Menorrhagia not only makes your daytime activities more difficult and can keep you from sleeping soundly at night, it is also a direct health concern, as excessive blood loss contributes to anaemia. If you suspect your menstrual flow is heavier than it should be, consult your doctor to determine the cause.

Is my period blood loss volume normal?

On average a woman loses between 30–40 ml of blood during her period, or even up to 60 ml—between two and four tablespoons. Many women who experience their menstrual blood flow as heavy are not losing more than 80 ml.

There is great variability in what is normal for a human body and the volume of blood you lose during menstruation can vary from month to month, but if you suspect a problem, take steps to discover what is going on.


Even if you bleed a little more or less than the ‘average woman’, your monthly blood loss is probably normal for you.

How can I measure my period blood flow?

To find out if your period blood loss falls within the average, you can actually measure it. This isn’t an easy task, but it is certainly possible if you are committed.

Using a menstrual cup. One of the simplest methods of measuring menstrual blood volume is using a menstrual cup—depending on the brand and model, your menstrual cup likely holds 30 to 60 ml. Some cups even have volume markings on the side for easy measurement.

Each time you empty your cup, take note of the volume and discard the blood. When your period stops, add up the numbers you get to find out the total volume of blood you lost this month.


In most cases, tissue, mucus, bits of the uterine lining, and blood clots add volume to the menstrual fluid—this is why taking accurate measurements is difficult.

Counting tampons. You can also get a decent approximation of how much menstrual blood you lose by counting the number tampons you go through. Most regular-size tampons hold 5 ml of fluid, but super-size tampons can absorb 10 ml. To absorb 60 ml of blood you need 12 regular tampons or 6 super tampons.

Keeping track of sanitary pads. An even simpler way of getting an approximate measurement is by keeping track of how many sanitary pads you use. If you need to change them about every two hours, your period is probably ‘average’. Here again, regular pads absorb about as much as regular tampons, 5 ml, and super absorbent pads can hold as much as super-size tampons, or 10 ml.

When is bleeding considered heavy?

According to many sources a period is considered ‘heavy’ when you lose more than 60 ml of blood and your period lasts longer than 7 days. Some sources say up to 80 ml blood loss still falls within the normal range.

Menstruation with abnormally heavy or prolonged bleeding in a regular cycle is called menorrhagia. Although heavy menstrual bleeding is not uncommon, only a small number of women experience blood loss severe enough to be defined as menorrhagia. Menorrhagia interferes significantly with your usual activities because of excessive blood loss and severe cramps.

Talk to your doctor if:

  • you change tampons or pads every hour or more often for several hours in a row
  • your period lasts longer than a week
  • you use double protection—tampon plus pad—to avoid leaks (or get even more creative, e.g. use a diaper)
  • you have blood clots larger than a thumbnail in your menstrual discharge
  • you are forced to limit your activities because of your period (for example, you leave school/work to change clothes or wake up several times during night to change the pads)
  • you experience fatigue, shortness of breath, or other signs of anaemia (when you lack healthy red blood cells to carry the necessary oxygen to your body’s tissues)

In most cases your doctor will be able to help you discover the cause of your heavy blood loss. A variety of tests can be used to determine the underlying cause and suggest an effective treatment.


Common causes of menorrhagia include:

  • Uterine fibroids and/or polyps. These are benign uterine tumours that appear during a woman’s reproductive years. Uterine fibroids can cause heavy or prolonged menstrual bleeding and also cause bleeding between periods.
  • Hormone imbalance. The balance between the hormones oestrogen and progesterone normally regulates the build-up and shedding of the uterine lining or endometrium. When a hormone imbalance occurs, the endometrium may develop in excess and eventually be discharged from the body in the form of heavy menstrual bleeding.


A number of conditions can cause hormone imbalances, including polycystic ovary syndrome (PCOS), obesity, insulin resistance, and thyroid problems.

  • Ovarian dysfunction. When the ovaries don’t release an egg during the menstrual cycle, the body doesn’t produce progesterone when it normally would. This leads to hormone imbalance and can result in menorrhagia.
  • Adenomyosis. When glands from the endometrium become embedded within the uterine muscle. This condition often results in heavy bleeding and painful periods.
  • Using an IUD (intrauterine device) for birth control. Menorrhagia is an uncommon, but recognised side effect of using a nonhormonal (copper) intrauterine device. If the IUD doesn’t work for you, other methods of contraception are available.

Other possible causes of excessive menstrual bleeding include uterine cancer, cervical cancer, liver disease, kidney disease, and bleeding disorders such as von Willebrand’s disease. Certain medications can also contribute to heavy or extended menstrual bleeding, including anti-inflammatory drugs, anticoagulants, and hormonal medications such as oestrogen and progestin.

Whether the cause ends up being trivial or serious, be proactive about getting a diagnosis so you can begin to feel better again.

There may be complications…

If heavy or extended menstrual bleeding is ignored, you can expect it to lead to other problems, the most likely being blood loss anaemia. Menorrhagia can cause severe Anaemia is defined as not having enough haemoglobin in the body. Red blood cells contain haemoglobin; it is a red pigmented protein that carries oxygen to tissues throughout the body. When the body lacks haemoglobin, it uses your iron stores to make more red blood cells and thus depleting the level of iron in the rest of your body. Menorrhagia causes excessive blood loss, which reduces the number of red blood cells in circulation in your body, leading to both anaemia and iron deficiency.

Weakness, fatigue, and pale skin are all indications that you may be anaemic.


Women with normal periods may be anaemic for other reasons. Be aware of the symptoms to catch and resolve the issue in its early stages, before it becomes a more serious problem.

How is menorrhagia diagnosed?

To determine a diagnosis, your doctor will ask you about your medical history and your menstrual cycles:

  • How old were you when you got your first period?
  • How long is your menstrual cycle?
  • How many days does your period usually last?
  • How many of those days is the blood flow heavy?
  • How do your periods affect your quality of life?

Your doctor may also ask about your family medical history—have other family members have experienced heavy menstrual bleeding?

To arrive well-prepared for the visit, track your periods with our app or simply write down the dates and note how heavy your flow is (try counting the number of pads or tampons you use).


Providing your doctor with reasonably accurate information about your period will get you a diagnosis sooner.

A physical exam and medical testing can help your doctor reach a diagnosis. A blood test can determine if you are suffering from an iron deficiency or anaemia; a pap smear looks at cells taken from your cervix to identify infection, inflammation, or signs of cancer; an ultrasound uses sound waves to create a picture of internal structures in the body and can reveal cysts or other abnormalities; and an endometrial biopsy is when your doctor takes a tiny tissue sample from the uterine lining and sends it to lab to be looked at under a microscope to determine if the cells are healthy.

Before giving you a diagnosis of menorrhagia, your doctor will want to rule out other possible causes.

How is it treated

The treatment you receive will depend on the cause and severity of your bleeding. Factors such as age, general health, and medical history. How well your body responds to medications and procedures will also be taken into consideration.

Be sure to discuss your wants and needs with your doctor. Some women just want to reduce the amount of bleeding, others are happy to be rid of it; for some it is important to know what they can expect from their cycle and for others not losing the possibility having children is the overriding concern. Once all options have been discussed, you and your doctor are in a better position to decide on the best approach for you.

Most commonly used drug therapies for menorrhagia include:

  • Painkillers can reduce menstrual pain and cramping
  • Iron supplements can restore iron to build the red blood that carry oxygen if you show signs of anaemia
  • Hormone-based contraception (pills or IUD) or hormone therapy can help regulate your period and reduce the amount of bleeding

Sometimes a surgical technique offers the best solution:

Dilation and curettage—the upper layer of the uterine lining is removed to reduce menstrual bleeding; this procedure may need to be repeated over time.

Operative hysteroscopy— a special tool is used to visualise the interior of the uterus to helps the surgeon remove polyps and fibroids, correct abnormalities, and reduce the lining of the uterus to manage a menstrual flow.

Ablation or resection of the endometrium—two different techniques in which all or part of the lining of the uterus is removed to control menstrual bleeding. While some patients will stop menstruating completely, others may continue to menstruate, but the menstrual flow will be lighter than before. Although the uterus remains intact, women who undergo either procedure won’t be able to bear children in the future.

Hysterectomy. A major operation requiring hospitalization which involves surgically removing the entire uterus. After undergoing this procedure, a woman can no longer get pregnant and will stop menstruating.

A heavy period needn’t be a ‘given’ that will annoy you throughout your fertile years. If you are bleeding heavily at that time of month, the scope of available treatments should encourage you to consult your doctor about options for improving your situation.

You can track your period using WomanLog. Download WomanLog now:

Download on the App Store

Get it on Google Play

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