No two periods are alike, which makes it difficult to gauge what's considered "normal" in the menstrual cycle space. What you may call a regular, shmegular period may be totally unusual for your friends and vice versa — creating a bit of murky territory when it comes to figuring out if something is in fact abnormal. That's why we're so adamant about track, track, trackiiiing your cycle in order to figure out what's normal for YOU.
With that said, when it comes to the volume of your flow, a period is considered "heavy" if...
- you're consistently bleeding for more than 7 days straight
- you're consistently passing blood clots that are larger than 2cm
- you're bleeding through 1 or more tampons/pads each hour for more than a few hours
- you're experiencing symptoms of anemia, including exhaustion, dizziness and/or shortness of breath
Periods can inevitably be a nuisance and inconvenience for us (hands up if you've unexpectedly bled through your nice white jeans...), but if you're finding that the volume of your menstrual bleeding is severely impacting your quality of life — it's best to check in with your doctor to see why you're experiencing menorrhagia, the medical term for heavy menstrual bleeding. Menorrhagia affects anywhere from 27% to 54% of people who menstruate, so don't stress if you think you may fall into this category. Acknowledging that something may be awry is the first step to isolating the issue and getting things back on track.
So, what are the potential causes of menorrhagia?
1. Hormonal imbalances
Surprise, surprise: checking for any hormonal imbalances is usually the first step into figuring out why you may be experiencing a super heavy flow. Conditions that affect the careful balance of your hormones — thyroid disease, polycystic ovary syndrome (PCOS) and anovulation (when an egg isn't released during your menstrual cycle) — can often lead to menorrhagia.
But as we know all too well, our hormones are greatly affected by a myriad of other factors. Things like stress, exercise, changes in diet, excessive weight loss/weight gain or the morning after pill can all lead to fluctuations in our hormones, which can ultimately affect the heaviness of our period. Try to take note of any drastic changes to your body or lifestyle in order to isolate a potential cause.
2. Non-cancerous growths in your uterus
Fibroids, polyps and adenmyosis are all examples of benign (non-cancerous) growths in your uterus. If you and your doctor have ruled out hormonal imbalances as the root cause of your menorrhagia, your doctor will likely check your uterus for any abnormal tissue growth. Keep in mind that roughly 75% of people with uteruses will develop fibroids at some point throughout their lives, so if you've been diagnosed with any of the above conditions, know that you're not alone in your diagnosis. Small fibroids usually don't require any treatment, but larger growths can be treated with medications or surgery if necessary.
3. Sexually Transmitted Infections
While menorrhagia is a lesser known symptom of certain sexually transmitted infections, it's important to know that gonorrhea, chlamydia, chronic endometritis and trichomoniasis may cause heavy bleeding. After speaking with your doctor and evaluating your symptoms, they'll be able to determine if an STI screening is necessary to rule this out as a cause. But don't fret if this is the case — the STIs stated above are totally treatable, meaning your menorrhagia will be reversible.
Aspirin and other blood thinners, hormone replacement therapy, tamoxifen (a drug used for breast cancer), IUDs, thyroid medicines and birth control pills may all cause an increase in menstrual bleeding. If you're taking any of these medications or currently have an IUD in place and you're experiencing menorrhagia, check in with your doctor to determine whether it could be a side effect from the medicine or implant.
5. Other medical conditions
Menorrhagia can be a symptom of various conditions: liver disease, kidney disease, pelvic inflammatory disease (PID), Von Willebrand disease, platelet disorders or leukemia. But keep in mind that these conditions will likely be accompanied by many other symptoms, not just menorrhagia.
6. Cancerous growths in your uterus
Cancers that affect your reproductive system, including uterine and cervical cancer, can cause heavy menstrual bleeding. The likelihood of this diagnosis is higher for people who are post-menopausal and/or have had an abnormal Pap test in the past.
Effective treatment for menorrhagia will of course depend on the root cause of your heavy bleeding and can vary from simple lifestyle changes to pain medications to hormone therapy to endometrial ablation (a procedure that removes a thin layer of tissue that lines the uterus). In severe cases, surgery may be the best option in order to alleviate the pain and accompanying symptoms. As we always say: be sure to check in with your doctor if you find that the heaviness of your flow (or any other menstrual symptom) is impeding your day-to-day life.
Image credit: Monika Kozub (Unsplash)