Your period tends to serve as a temperature check for what's going on in the rest of your body. So if the bleeding has gotten really heavy and uncomfortable, there's a good chance something else is going on.
Heavier-than-normal periods are typically defined as having to change your tampon or pad after less than two hours or passing clots that are bigger than a quarter. That said, any time your period seems to veer off from your normal for more than a cycle or two, it's worth paying attention, says Jennifer Wu, MD, an ob-gyn with Lenox Hill Hospital in New York.
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That's not to say that heavy bleeding always indicates a major problem. Often, the culprit is a harmless fibroid, wrong-for-you birth control or hormonal shifts like perimenopause. If you're wondering why your period is so heavy, here are some potential things you might be dealing with, plus the best options for getting your period under control.
1. You Have a Benign Fibroid
Fibroids are harmless (read: not cancerous) balls of muscle tissue, but they can have a major effect on your period.
"They're very common, and if they're located inside of the uterus lining, they can affect the heaviness of a woman's flow," Dr. Wu says.
That's because excess blood flows into the fibroid itself, which then gets shed along with the blood in the uterus lining that normally leaves your body during your period. They can also cause back pain and pain during sex.
Fix it: Medications like birth control pills, gonadotropin-releasing hormone (GnRH) antagonists and antifibrinolytic meds can manage heavy bleeding caused by fibroids. If the meds don't help, or if the fibroid are causing other symptoms that are interfering with your everyday life, you and your gynecologist can discuss the option of having the fibroid surgically removed, according to the Cleveland Clinic.
2. Your Period Came Late
If your last cycle was longer than usual, your period might be heavier and crampier when it does arrive, since more blood has had a chance to build up in the lining of the uterus, Dr. Wu says. Cycles that are more spaced out than typical are especially common for people going through perimenopause and younger individuals who just recently started menstruating, she adds.
Fix it: One longer or unusual cycle isn't necessarily cause for concern. But if your periods have gotten more spaced out or irregular, let your gynecologist know. Together you can figure out the underlying cause, whether it's menopause, a hormonal imbalance or something else.
3. It's Your First Postpartum Period
Pregnancy and childbirth can increase the size of your uterine cavity, creating more uterine lining that can then be shed in the form of your monthly period, per the Cleveland Clinic. As a result, "the first period after having a baby tends to be very heavy and long," Dr. Wu says.
You might notice more cramps too, especially if you gave birth via C-section, per October 2017 research published in Medical Hypotheses.
Fix it: Your periods might start to feel more normal after another cycle or two. But tell your gynecologist if they're still unusually heavy or causing uncomfortable side effects after a few months. You can talk about options to regulate your flow, like hormonal birth control, or investigate possible underlying causes, like hormonal disorders or complications that happened during pregnancy or birth.
4. You Have a Hormonal Imbalance
The hormones estrogen and progesterone normally work together to regulate your monthly period. But your cycle can become heavier or lighter when the two are out of whack, Dr. Wu says.
Some of the most common things that can lead to a hormonal imbalance and effect your cycle include polycystic ovary syndrome (PCOS), insulin resistance, thyroid problems and obesity, according to the Mayo Clinic.
Fix it: Make an appointment with your gynecologist to discuss your symptoms. Getting your hormones back into balance starts with determining the underlying cause.
5. You Have an IUD
It's common for copper IUDs (such as Paraguard) to make periods longer and heavier, as well as leading to more spotting and cramping. The copper may cause changes to the blood vessels in the uterus, which can increase blood flow, per October 2008 Contraception research.
Fix it: Many people who menstruate find that the increased bleeding and cramping from the copper IUD gets better on its own within three to six months after insertion, according to Planned Parenthood. (In the meantime, you can try these strategies to ease period cramps.)
If the problem isn't easing up, you can talk with your gynecologist about switching to another form of birth control, Dr. Wu recommends. Hormonal IUDs (such as Mirena) often have the opposite effect, making your period super light. Birth control pills can make your period lighter and more regular too.
6. You're Taking Blood Thinners
Anticoagulants that prevent your blood from clotting, such as warfarin or enoxaparin, can increase bleeding risk in general. So it's common for them to make your periods longer and heavier too, per the Mayo Clinic.
Fix it: Let your gynecologist know if your blood thinners are making your periods unusually heavy. They might recommend a hormonal IUD to reduce bleeding. In some cases, endometrial ablation can also be used to remove a thin layer of the uterine lining, which can also lessen bleeding, Dr. Wu says.
7. You Have Adenomyosis
Adenomyosis happens when tissue that normally lines the uterine lining grows into the uterine muscle wall. The problem, which most often affects people with uteruses ages 35 to 50, can cause very heavy periods, severe cramping and pain during sex, says the Cleveland Clinic.
Fix it: Depending on your how intense your symptoms are, you may be able to manage the bleeding by taking birth control pills or trying a hormonal IUD, Dr. Wu says. In more severe cases, you and your gynecologist might consider surgical options like a hysterectomy.
Listed above are just some of the potential causes for heavy bleeding during your period; others include:
- Uterine or cervical cancer, particularly if you're postmenopausal or have had abnormal pap smears in the past, per the Mayo Clinic.
- Blood disorders, such as Von Willebrand disease, according to the Centers for Disease Control and Prevention (CDC). Low platelet counts can also be a factor, per University of Utah Health.
- Other illnesses or disorders, such as liver or kidney disease, according to the CDC.
When to See a Doctor
One unusually heavy period may not be cause for concern. But if your period is suddenly very heavy month after month, or if heavy periods are impacting your lifestyle, you should let your gynecologist know.
"Some patients call out of work for those one or two days, or they have certain outfits for those days, or they won't plan big meetings or vacations," Dr. Wu says. "But you should still be able to function pretty normally during your period. You should still be you."
- Cleveland Clinic: Uterine Fibroids
- Cleveland Clinic: "Do Your Periods Change After Pregnancy?"
- Medical Hypotheses: "Caesarean section scar causes myometrial hypertrophy with subsequent heavy menstrual flow and dysmenorrhoea"
- Mayo Clinic: "Menorrhagia (heavy menstrual bleeding)"
- Contraception: "Subendometrial microvascularization and uterine artery blood flow in IUD-induced side effects (levonorgestrel intrauterine system and copper intrauterine device)"
- Planned Parenthood: "What are the side effects of IUDs?"
- Cleveland Clinic: "Adenomyosis"
- University of Utah Health: "CAUSES OF HEAVY PERIODS"
- Centers for Disease Control and Prevention: "Heavy Menstrual Bleeding"
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.