1 in 3 Women Experience Heavy Menstrual Bleeding. Here's How to Manage It
Piyapong Thongcharoen / Getty Images
Fact checked by Nick Blackmer
Key Takeaways
Heavy menstrual bleeding is more excessive or longer-lasting than a regular period.
Individuals with heavy menstrual bleeding experience disruption in their daily lives because of their condition.
There are several treatment options for heavy menstrual bleeding, depending on individual patient factors and the cause.
One in three women of childbearing age experience heavy menstrual bleeding (HMB), but many don’t receive proper treatment. That’s often because they don’t know HMB is a condition—and a treatable one, at that.
Bayer is drawing attention to heavy menstrual bleeding with their Seeing Red campaign, arming people with the information they need to know when discussing their condition with their providers.
“Women have deprioritized our health to a point worse than before the pandemic,” said Yesmean Wadhan, MD, an OB/GYN and Vice President of US Medical Affairs for Women’s Healthcare at Bayer Pharmaceuticals. “HMB is one of those conditions that we know women experience and suffer with in silence before reaching out.”
From medications to surgical procedures, here are the interventions that can treat heavy menstrual bleeding, and how to know if your symptoms warrant a conversation with your doctor.
Related: Heavy Menstrual Bleeding (Menorrhagia)
What Is Heavy Menstrual Bleeding?
A normal menstrual cycle occurs about once every four weeks, lasts 4 to 5 days, and results in blood loss of 1 or 3 tablespoons. Heavy menstrual bleeding, on the other hand, is a menstrual flow over 1/3 of a cup per cycle, lasting longer than 7 days, or having multiple periods in four weeks. You should seek medical expertise if you experience any of the following:
Blood clots larger than the size of a quarter in your menstrual flow
Changing your tampon or sanitary pad more often than every hour during the day or needing to double up on feminine hygiene products
Changing your feminine hygiene product during the night
Avoiding social activities or planning events around your period
Having to pack extra clothing in case of an accidental leak
“Heavy menstrual bleeding can impact day-to-day life physically, mentally, and emotionally,” Wahdan told Verywell. People with HMB may avoid social gatherings due to fear of bleeding through their clothing. HMB can impact intimacy between a partners. It may also place a financial burden on people who need many sanitary products.
Another potential consequence of HMB is iron deficiency anemia, which can make people feel tired or short of breath, and may require a blood transfusion in severe cases.
Causes
Heavy menstrual bleeding is a symptom of another underlying cause, so you should see a provider to find out why you are bleeding. The most common causes include:
Uterine issues such as polyps, fibroids, adenomyosis, and endometriosis can cause heavy menstrual bleeding.
Heavy menstrual bleeding can also result from abnormal hormone levels, such as thyroid irregularities and polycystic ovarian syndrome (PCOS).
Medications that prevent blood clots, like aspirin, may increase your menstrual flow.
Less common causes of heavy menstrual bleeding include endometrial cancer, ectopic pregnancy, and pelvic inflammatory disease.
Navigating Your Treatment Options
Your treatment options will depend on many factors, including the cause of your bleeding, your age, coexisting health conditions, and whether or not you wish to get pregnant:
Medications
Oral contraceptives (birth control pills) regulate the menstrual cycle and can reduce the amount of bleeding with each cycle. They are a reversible form of birth control, so they are suitable for women wishing to get pregnant in the future.
For those on the path to surgery, gonadotropin-releasing hormone (GnRH) agonists may be a better option. These drugs block the body from producing estrogen and progesterone, which cause the uterine lining to build up.
“GnRH medications work by turning off the ovaries, causing temporary menopause,” Monte Swarup, MD, FACOG, a board-certified OB/GYN in Chandler, Arizona, and founder of Vaginal Health Hub, told Verywell via email. “GnRH is a good option for people waiting for surgery.”
Another medication, tranexamic acid, slows the breakdown of blood clots, thus reducing the amount of bleeding with each cycle. It is taken at the beginning of the menstrual cycle and not all month long. Because tranexamic acid increases blood clotting, it is not a suitable option for patients with a high risk of developing blood clots.
IUDs
The Mirena IUD is an intrauterine device (IUD) is a small, T-shaped object placed inside the uterus to provide long-term reversible contraception. While many other IUDs can lessen menstrual bleeding, Mirena is the only IUD that is FDA-approved to treat heavy menstrual bleeding. It releases continuous, low levels of hormones that prevent the uterine lining from thickening and may stop periods altogether in some women. Mirena also provides long-acting, reversible contraception for women who may want to conceive later.
Ablation & Embolization Procedures
Endometrial ablation burns and destroys part of the uterine lining (endometrium). Ablation will not completely stop periods, but it will cause them to be much lighter.
“Endometrial ablation should be considered if therapies and medication have not worked,” Swarup told Verywell.
Pregnancy after endometrial ablation is unlikely but poses a risk of miscarriage, so it is not a suitable option for women who still wish to bear children.
A procedure used to treat fibroids, called uterine artery embolization (UAE), may also be an option for heavy menstrual bleeding.
“UAE blocks the blood vessels in the uterus that feed the lining of the uterus and prevents fibroids from growing,” said Swarup.
Surgery
Surgery can alleviate some of the uterine causes of HMB. A myomectomy removes fibroids but leaves the uterus intact. Hysteroscopy removes fibroids, polyps, or endometriosis, which can decrease bleeding.
Swarup says if no other treatments have helped, a hysterectomy to remove the uterus is an option, but “this is done when other treatments have failed.”
Talking to Your Healthcare Provider
It may be intimidating to speak with your provider about HMB, but that is the first step to finding the best treatment plan for you.
“Track your health concerns and bring your questions to your appointment and get them answered,” Swarup said. “Stay informed and educated about your condition by reading medical information online from trusted sources,” such as the American College of Obstetricians and Gynecologists (ACOG).
Don’t feel discouraged if you need to seek a second opinion to find a solution to your HMB.
“If someone feels that they aren’t getting the support they feel they need, it’s OK to seek another opinion,” Wahdan says. “Keep pursuing it, because there are options out there that will address the condition and help you have a more fulfilling life.”
