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Abnormalities of Menses: Heavy Menstrual Bleeding


Heavy period flow

Did you know how common is heavy menstrual bleeding? Let me tell you, worldwide almost 8% to 27% of women have sometimes suffered with heavy periods at some points in their lifetime. Many women with heavy periods miss their school, college, work days, they become anemic, they become tired, lethargic and their productivity is decreased. So if you too dread your periods because they are heavy, let's go along and understand how does this happen and what can you do about it. So today, let's talk about when the going gets too heavy. 

What is a heavy period? 

Actually it is little bit subjective, many women actually feel that they are bleeding heavily but actually the bleeding is normal. While many women feel it's a normal period while the bleeding could be actually very heavy. 

So how do we objectively define if your period is heavy? If you are bleeding for more than seven days, if you are passing clots which are typically more than two centimeters in size, if your period causes flooding which means that your clothes, your bed sheets, your even furniture gets stained by the period flow or in case you have to change your menstrual pad or a tampon which is fully soaked more than five or six times a day or you need to change it more than once in one hour or in case your periods actually cause your hemoglobin to drop, your period causes tiredness, lethargy and weakness, yes it is a heavy period. 

What causes period to be heavy 

So now let's understand what causes the periods to become heavy. The causes could be very simple while some of the causes could be actually very serious too. 

1. Hormonal imbalance

The first cause of the heavy period could be a simple hormonal disturbance. It could be a thyroid problem or maybe a PCOD. This actually causes the cycles to become anovulatory which means the ovulation is not happening. 

When the ovulation does not happen the endometrium actually becomes very thick because of unopposed estrogen, because there is no progesterone. 

So the treatment could be very simple just the treatment of a thyroid or a PCOD and the periods could be back on the track.

2. Uterine fibroids 

The second most common cause of heavy periods is uterine fibroids. Uterine fibroids are actually non-cancerous tumors of the uterine muscle. These fibroids could be small, large, single, multiple.

They could be placed at various places in the uterine muscle. Some of the fibroids which are projecting inside the cavity of the uterus. These are known as submucosal fibroids are more likely to cause heavy periods.

While some fibroids could be just inside the uterine muscle. These are known as intramural fibroids and some of the fibroids are actually protruding outside the uterus. These are known as subserosal fibroids and these are unlikely to cause heavy periods.

3. Uterine polyp

The next cause of the heavy period is uterine polyps. Uterine polyps are very soft grape like soft tumors which are projecting inside the uterine cavity. 

4. Pelvic infections 

The next cause of the heavy period could be uterine or pelvic infections. So in case you have associated pain in the lower abdomen, a dirty vaginal discharge or maybe a history of a painful sex. Then probably the pelvic infection is the reason of heavy periods. And once again we treat the infection the heavy periods will get sorted out.

5. Endometriosis 

The next important cause of heavy period is endometriosis. In endometriosis, the periods are painful too in addition to being heavy also. In this condition the endometrium which is the inner lining of uterus is also present outside the uterus most commonly on the surface of tubes and ovaries.

6. Miscellaneous causes 

The next important cause of heavy period is many women who use Cupper T IUD, also complain of heavy periods. A very unusual cause of heavy period could also be an undiagnosed pregnancy which is actually in the process of miscarriage. So here a woman just misses her period and if she is aborting she actually comes to the doctor with a heavy bleeding. But this problem typically is there for that cycle only and the problem does not persist further. 

Many times the cause of a heavy period in a young girl could be a clotting defect. This is a hereditary problem, in this case, the blood fails to clot properly and this problem gets manifested for the first time when a girl starts having her periods. 

A very serious reason of heavy periods which is typically seen in older women is uterine malignancies or pre malignancies. The malignancy could be affecting the endometrium or it could be affecting the cervix which is endometrial cancer or the cervical cancer.

Very rare causes of heavy periods could be also what are known as AV malformations in the uterus. These are abnormal arteriovenous malformations inside the uterine cavity. So every month the bleeding could be very heavy.

Heavy period flow

How to diagnose heavy period 

So what is to be done in case you are having heavy periods? Number one, do not ignore your symptoms. Number two, most important, never get a prescription from Dr. YouTube or Dr. Google and do not pop in over the counter medications just like that. So most important, visit a gynecologist, get a proper diagnosis made.

The doctor is going to take a detailed history, do an abdominal examination, maybe an internal examination in case you are sexually active. The doctor might order an ultrasound of the pelvis, maybe an MRI of the lower abdomen and pelvis. Certain blood tests also may be ordered like a complete blood count, coagulation test, thyroid test, serum prolactin, maybe an LH and FSH ratio.

The doctor may also like to do what is known as hysteroscopy and an endometrial biopsy in case there are any suspicious findings on the ultrasound or the MRI of the pelvis. 

How to treat heavy period 

So now what are the treatment options which are available for heavy periods? Obviously the treatment depends upon the cause of the heavy periods. 

Number one, we correct the anemia, we treat the infections. In case you have any hormonal problem like a thyroid or PCOD, we treat that. There are certain drugs which are known as NSAIDs, non-steroidal anti-inflammatory drugs, they are drugs like tranexamic acid or mefenamic acid. They beautifully control the flow of the period. 

If all this does not work, then we like to use birth control pills, we also use some medicines called progesterone analogues. Progesterone is a hormone which can be used either in a tablet form or we put inside IUCD which is known as Mirena. Mirena is basically a intrauterine contraceptive device which has got a progesterone loaded inside it and it works beautifully to control the bleeding.

In case all this does not work, a surgical treatment may be required to remove the fibroids or the polyps. 

There are a lot of non-surgical options also available for treating the heavy periods like endometrial ablation where we actually thermally destroy the endometrium, uterine artery embolization where we actually block the artery supplying blood to the fibroids using certain special particles.

There is also a very recent technique which is known as HIFU, so high intensity focused ultrasound where special sound waves are directed to thermally destroy the fibroids inside.

In case all this does not work or maybe if all these facilities are not available at a particular place, the doctor may also decide to do a hysterectomy which is the removal of uterus and that is usually done in case the patient has completed her family. 

How to treat heavy period naturally?

So what can be done naturally to manage your heavy periods in addition to the medical treatment? 

Take an iron rich diet, make sure that your diet includes beans, legumes, green leafy vegetables, dried apricots, milk, raisins.

Avoid tea and coffee because it hinders the absorption of iron. Make sure that you're taking iron supplementation, folic acid, B12, vitamin C supplementation. Follow a plant based diet.

Make sure that you take lots of green leafy vegetables, lots of legumes and pulses. Avoid what is known as estrogenic dominance diet. So this means avoid refined, packaged and processed food.

Avoid non-organic red meat. Avoid soya products, especially if they contain GMOs. Avoid food additives, alcohol, plastic packaged food and water because the xenoestrogens which are present in the plastic actually leach into the food.

So make sure that you exercise, you lose weight, you keep your BMI under control, your insulin resistance is under control. There are a few herbs also which are known to help actually in heavy periods like ashwagandha, berberine, rosemary extract, even green tea. But make sure to discuss all these options with your doctor before you actually try them.

Closing thought

However simple this problem may sound, however common this problem is, please do not ignore it. Get the right diagnosis made, get the proper treatment done and give it the attention it actually deserves. 


2. National Collaborating Centre for Women's and Children's Health (UK). Heavy Menstrual Bleeding. London: RCOG Press; 2007 Jan. PMID: 21938862.

3. National Guideline Alliance (UK). Evidence reviews for management of heavy menstrual bleeding: Heavy menstrual bleeding (update): Evidence review B. London: National Institute for Health and Care Excellence (NICE); 2018 Mar. PMID: 33780205.

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