It's barely been an hour, and you're now rushing off to change your soaked pad. You've had heavy periods for as long as you can remember, but you can't help but wonder whether what you have is normal.
Heavy periods are common, and around 10-35% of menstruators report this issue during their reproductive years . Because of how prevalent it is, many regard heavy periods as part and parcel of adulthood—even if the issue causes significant discomfort and inconvenience.
To help you navigate your concerns, we've put together a guide that addresses the questions you might have about your menstrual flow.
In this article, we'll look at what's considered a heavy period, the possible causes of heavy periods, and when it's best to seek medical advice.
What is Menstruation, and What's Normal?
Menstruation, or your period, refers to the vaginal bleeding that occurs each month when you do not get pregnant. During a menstrual period, your uterus (womb) sheds its lining, which is discharged along with blood through the vagina .
The typical duration of a period is around 3-5 days, but flows lasting between 1-8 days can still be considered normal. On average, around 30mL of blood is lost during menses, which is about 2-3 tablespoons per cycle .
The average cycle length is about 28 days, based on textbook guidelines. However, this can vary widely because each person's cycle is unique . In fact, studies have shown that only around 16% of people have the standard 28-day cycle .
From this, you can see that the duration, flow, and timing of menstruation can vary widely from one person to another.
What is Considered a Heavy Period?
A heavy period is a period where you lose an excessive amount of blood due to heavy or prolonged bleeding .
A heavy period was objectively defined as the loss of more than 80 mL of blood during each menstrual cycle. However, the definition of heavy periods has been revised to be more inclusive and holistic .
Currently, a heavy period is defined as an excessive loss of blood during a menstrual period that impacts an individual's quality of life in the following ways :
Of course, the 80 mL marker is still used to help healthcare professionals and scientists define heavy bleeding in studies, research, or clinical settings .
Another indicator of a heavy period is the length of menstrual flow. Some research suggests that menses lasting longer than 7 days may be considered a heavy period .
You might also observe other physical signs and symptoms that point towards this issue, including the following :
- Heavy periods with clots larger than 1 inch in diameter
- Having to change a pad or tampon more frequently than hourly
- Symptoms of anaemia, such as tiredness, weakness, dizziness, or shortness of breath
How can you measure the amount of blood loss?
Keeping track of menstrual blood loss also allows you to quickly detect if there are any concerning changes or abnormalities.
Here's how you can estimate your menstrual blood loss each month.
A fully-soaked menstrual pad holds around 5 mL of blood. Meanwhile, a fully-soaked ultra-absorbent menstrual pad (nighttime use) can hold up to 15 mL of blood .
A fully-soaked regular tampon holds around 4 mL of blood. A more absorbent one (such as those labelled "Super") can hold 8 mL. An ultra-absorbent one (such as those labelled "Super Plus") can hold 12 mL of blood .
Depending on the brand, menstrual cups can comfortably hold around 10-38 mL of blood . Many menstrual cups come with volume markings indicating how much blood was lost.
Causes of Heavy Menstrual Bleeding
Heavy menstrual bleeding may happen for various reasons, including the following:
An abnormality with the uterus
The presence of fibroids in the uterus (non-cancerous growths) may cause abnormal bleeding patterns. Another condition associated with heavy menstrual bleeds is adenomyosis, which occurs when the tissue of your uterine lining grows into the muscular wall of the uterus .
Uterine polyps, also known as endometrial polyps, may also lead to heavy periods. Polyps are structures that form when the cells of the uterine lining overgrow .
Uterine cancer may also cause heavy menstrual bleeding. However, this form of cancer is more common in people aged 45 and up or people on estrogen-only hormonal therapy .
Problems with ovulation
Without ovulation, the uterine lining cannot shed regularly, so it may start to thicken. When ovulation finally occurs, the shedding of this thick lining causes heavy menstrual bleeding .
Problems with ovulation are usually associated with a hormonal imbalance. This can be brought about by various medical conditions, including thyroid disease or polycystic ovarian syndrome (PCOS) .
An abnormality with how your blood clots
Certain medications may change how your blood clots.
Anticoagulants and antiplatelet medications are common drugs prescribed to help prevent heart attacks, strokes, or other life-threatening ailments .
Because these medications interfere with the formation of blood clots in your body, you may be more prone to heavier menstrual periods .
If you experience this side effect, you should speak to your doctor.
Can Birth Control Cause Heavy Menstrual Bleeding?
There are various types of birth control methods available. And depending on the type of method you go for, you may experience changes in your menstrual patterns, such as amenorrhea (absence of menstruation), spotting, lighter periods, irregular periods, or heavier and more prolonged menses .
Heavier or prolonged periods may be a side effect of the following forms of birth control :
- Copper intrauterine device (IUD): Heavier or prolonged bleeding is a common side effect in the first 3-6 months of use.
- Birth control implant: An implant may cause prolonged or more frequent bleeding throughout the three years of use (implants need to be replaced every three years or so).
- Birth control injection: Heavier or prolonged bleeding are less common side effects but may still occur.
Impact of Heavy Menstrual Bleeds
Heavy menstrual bleeding can physically, emotionally, and socially impact an individual.
Firstly, regular heavy periods may cause iron-deficiency anaemia, a condition where your body does not have enough red blood cells to carry sufficient oxygen to your tissues. This can lead to fatigue and weakness .
Additionally, menstruators who experience heavy menses may find it more challenging to participate in physical and social or leisure activities compared to menstruators who have normal periods .
Understandably, dealing with heavy periods can cause emotional distress or concern. If you're worried about how much blood you lose each cycle, it's best to find a safe space to discuss your concerns with a trusted healthcare provider.
Ways to Manage Heavy Menstrual Bleeding
Some lifestyle changes you can make to manage heavy periods are as follows:
- Use menstrual cups as they can hold more blood.
- Opt for period panties, especially when sleeping at night (they soak up a large volume of blood).
- Get plenty of rest and stay well-hydrated.
Your doctor may also recommend treatment for heavy menses. The best treatment option for your case will depend on various factors, such as :
- Your age and preferences
- The likely cause of your heavy menses
- If you wish to become pregnant—whether soon or in the future
Medications for heavy periods
Your doctor may prescribe certain medications to help reduce and control the bleeding, such as the following :
- Combined oral contraceptives (COC) containing estrogen and progestin: These may come in the form of pills, vaginal rings, or hormonal patches.
- Progestin-only contraceptives: These may be oral pills, implants, or injections.
- Antifibrinolytic medications, such as tranexamic acid: They support your body's blood clotting system and, thus, reduce bleeding.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen: These medications help reduce bleeding while relieving menstrual cramps.
Surgery for heavy periods
Surgery may be recommended if certain growths, such as uterine fibroids, are the likely cause of your heavy menses. Your doctor may recommend any of the following procedures :
- Endometrial ablation: This procedure destroys most of the endometrial lining. It can significantly reduce bleeding or stop it altogether.
- Uterine artery embolisation: In this procedure, the blood supply to the uterine fibroids is cut off. This helps to eliminate the fibroids and resolves heavy bleeding resulting from fibroids.
- Hysterectomy: This major surgery removes your uterus and is a permanent cure for heavy menstrual bleeding.
When to See a Doctor for Heavy Periods
If your periods significantly affect your quality of life, it's best to seek medical advice. For instance, your menses may be heavy enough to hinder you from participating in physical or social activities or cause you to feel tired or weak.
Say you also experience other symptoms, such as painful menstrual cramps or irregular periods. In this case, seeking your doctor's advice is the best step to take.
Keeping track of what's considered normal in your cycle and flow also allows you to quickly detect changes and seek medical advice if necessary. And that's where the inne minilab can help.
The minilab is an at-home device that utilises quick and painless saliva tests to track your hormones and menstrual cycle. All your data is interpreted and recorded in the inne app, where you can also keep track of your symptoms throughout your cycle.
Essentially, the minilab empowers you to understand your menstrual patterns better and quickly detect abnormalities in your cycle. Cycle tracking through the minilab is a simple yet comprehensive way to take charge of your hormonal and menstrual health!
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