Heavy menstruation

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Many women experience discomfort during their period, such as pain, cramps, irregular or very heavy bleeding. If tampons or pads need to be changed more frequently than every few hours, bleeding is probably heavier than normal. It is clearly too heavy if it interferes with everyday life and the loss of blood weakens the body.

About 10 out of every 100 women have a period that is too heavy (hypermenorrhea). If the menstrual period lasts longer than 5 to 7 days, it is considered prolonged bleeding (menorrhagia). Both often occur together, as often the same cause is behind it.

Some women have developed good strategies to cope with their heavy periods. However, if the bleeding becomes too disruptive or leads to iron deficiency, medications can be used to lessen the bleeding. Another option is to have operated.

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Even though the amount of blood that drains during menstruation can feel larger at times: Normally, women lose a total of about 60 milliliters of blood during menstruation. This is equivalent to about one and a half shot glasses. With this amount of bleeding, it takes about four hours for a normal size tampon or pad to be full. However, this is only an average value, because the bleeding is stronger on some days and weaker on others.

In gynecology, a period is considered too heavy if a woman regularly loses a total of more than 80 milliliters of blood during her menstrual period. Whether such a loss of blood is perceived as a burden also depends on the general physical condition and other personal factors.

It may indicate too heavy a menstrual period if

  • a woman needs to change her pads or tampons regularly after only 1 to 2 hours, or to empty her menstrual cup after only a few hours,
  • she quickly feels weak, tired and listless during her period, and
  • her menstrual blood contains many thick blood clots.

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Some girls have a very heavy menstrual period right from the start. For most women, however, the bleeding only becomes heavier at a later time, for example after giving birth or after inserting an IUD for contraception. Hormonal changes, such as menopause , can also contribute to it.

The most common cause of excessive menstruation is that the uterus cannot contract properly. Contracting usually helps loosen the lining inside the uterus so it can be flushed out with some blood. It also ensures that the bleeding does not last too long.

Contraction of the uterine muscles is impeded when larger benign growths such as fibroids and mucosal polyps interfere. Polyps grow in the lining of the uterus, fibroids grow in the muscular layer of the uterus. IUD can also disrupt the uterine muscles.

Adhesions on the uterus are also a common cause of heavy bleeding, as is inflammation of the uterus or fallopian tubes. Adhesions can be congenital, but can also develop after surgery or as a result of extensive endometriosis. Malignant growths such as uterine or cervical cancer very rarely cause excessive menstrual bleeding.

Rarely, other medical problems such as hormone imbalances, blood clotting disorders, heart, kidney, thyroid or liver disease can also trigger increased menstrual bleeding. Sometimes, however, no clear cause can be found.

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If too much blood and thus iron is lost during the period, this can lead to an iron deficiency. Iron is very important for building red blood cells. If there is too little iron in the body, not enough red blood cells can be produced and anemia occurs.

Red blood cells carry oxygen in the blood to organs. If there are not enough red blood cells, the body is less well supplied with oxygen – the result is weakness and fatigue. Other possible signs of anemia can be pallor and cold hands and feet. If anemia is more severe, other symptoms such as shortness of breath and rapid heartbeat may also appear, especially after physical exertion.

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First of all, it is important to find out how much blood loss there is during the period. The amount of blood cannot be determined exactly, but at least it can be estimated. A clue is given by the number of pads or tampons needed on different days during a menstrual period – or the frequency with which a menstrual cup has to be emptied. It can be helpful to keep a written record of this for 1 or 2 months – for example, in a diary .

To find out the cause of heavy menstrual bleeding, the uterus is usually examined first. The doctor palpates her and does an ultrasound examination . Sometimes a hysteroscopy is also recommended, where a small camera is inserted into the uterus.

A blood test can show if heavy menstruation has led to anemia. The amount of certain hormones in the blood that influence the uterine mucosa and the menstrual cycle can also be determined.

The personal situation and the nature of the complaints can provide further important clues to possible causes. It is therefore important to talk to the doctor about existing illnesses, illnesses in the family, the use of medication, weight problems and psychological stress.

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Depending on the cause of heavy menstrual bleeding, there are several treatment options:

  • DrugsThere are special drugs to reduce the bleeding tendency. In addition, many women take painkillers, which at the same time weaken the bleeding a bit. These drugs, such as ibuprofen or diclofenac, belong to the group of nonsteroidal anti-inflammatory drugs ( NSAIDs ). Acetylsalicylic acid ( ASS ), however, is not suitable for menstrual bleeding.
  • Hormonal remediesContraceptives such as the contraceptive pill or hormonal IUD reduce menstrual bleeding by inhibiting the growth of the lining of the uterus.
  • SurgeryIf the symptoms are severe and there is no longer a desire to have children, the lining of the uterus can be removed or sclerosed (endometrial resection or ablation). A major operation is the removal of the uterus (hysterectomy). It is only considered for very severe and distressing symptoms. Fibroids, polyps or other benign tissue growths in the uterus can also be removed by surgery.

As long as heavy menstrual bleeding does not lead to anaemia, it does not necessarily need to be treated.

For women considering starting treatment, it is important to know and weigh the pros and cons of medications or surgical procedures. A decision aid that clearly summarizes the advantages and disadvantages of the various treatments can be helpful here.

Which therapy is suitable also depends on whether you wish to have a child or not. Because the most effective treatments limit the possibility of getting pregnant – either temporarily, such as the pill, or permanently, such as removal of the uterus.

More knowledge

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Heavy menstrual bleeding can interfere with many activities and lead to tiredness and fatigue. In addition, the bleeding can simply disturb, or be associated with feelings of shame. However, there are ways to cope better in everyday life. On days with particularly heavy bleeding, for example, you can make sure that there is always a toilet nearby, and combine tampons or menstrual cup with pads. It may be wise to always keep some hygiene items at work or in your purse. Wearing dark pants or skirts during menstruation can take away the worry that blood stains will show on clothing.

Beckermann MJ, Perl FM. Gynecology and obstetrics. Integrating Evidence Based Medicine into Women-Centered Gynecology. Basel: Schwabe; 2004.

German Society of Gynecology and Obstetrics (DGGG). Indication and methodology of hysterectomy for benign disease (S3 guideline). AWMF registry no.: 015-070. 2015.

National Institute for Health and Care Excellence (NICE). Heavy menstrual bleeding: assessment and management (NICE guidelines; Volume NG88). 2020.

Singh S, Best C, Dunn S et al. No. 292-Abnormal Uterine Bleeding in Pre-Menopausal Women . J Obstet Gynaecol Can 2018; 40(5): e391-e415.

Sriprasert I, Pakrashi T, Kimble T et al. Heavy menstrual bleeding diagnosis and medical management . Contracept Reprod Med 2017; 2: 20.

IQWiG health information to help understand advantages and disadvantages of important treatment options and health care offerings.

Whether one of the options we have described is actually useful in an individual case can be clarified in consultation with a doctor. Health information.de can support, but not replace, the conversation with doctors and other professionals. We do not offer individual advice.

Our information is based on the results of high-quality studies. They are written by a team of authors from medicine, science and editorial staff and peer-reviewed by experts from outside IQWiG. How we compile our texts and keep them up to date is described in detail in our methods .

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Updated on 05. May 2021
Next planned update: 2024

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