A typical menstrual period is a natural and regular part of the reproductive cycle for many individuals. Understanding what constitutes a normal period is the first step in identifying when bleeding might be excessive. A normal menstrual cycle generally spans 21 to 35 days, with the actual menstrual flow typically lasting between 4.5 and 8 days.1 The average blood loss during this time is relatively modest, amounting to approximately 2 to 3 tablespoons, or 35 to 40 milliliters.2 To put this into perspective, this volume is roughly equivalent to 1.5 shot glasses, and a standard tampon or sanitary pad would typically take about four hours to become fully saturated at this rate of flow.4
However, for many, menstrual bleeding can deviate significantly from these norms. Heavy menstrual bleeding, medically termed menorrhagia, describes an excessive or unusually prolonged loss of blood during your period.3 This condition is remarkably common, affecting a substantial portion of the population. Approximately one in four individuals experience heavy periods 7, with some estimations indicating that abnormal uterine bleeding, a broader category that includes menorrhagia, impacts between 10% and 35% of females.8 The widespread occurrence of this condition underscores its significance as a public health concern, highlighting the necessity for widespread awareness and accurate information.
The prevalence of heavy menstrual bleeding is particularly notable during specific life stages. It is frequently observed when individuals first begin menstruating, typically around the age of 12, and again during perimenopause, which generally commences around age 40 and beyond.1 This pattern is often attributed to the hormonal fluctuations and the higher incidence of anovulatory cycles that characterize these transitional periods in reproductive life.1 The understanding that heavy bleeding is common during these specific life stages, due to predictable hormonal shifts, moves beyond a simple attribution to “hormonal imbalance” and provides a deeper appreciation of the underlying physiological mechanisms. This detailed understanding is valuable for both individuals experiencing these symptoms and healthcare providers.
The ability to recognize the signs of excessive blood loss is paramount. Untreated heavy or prolonged bleeding can have a profound impact on an individual’s quality of life, leading to significant disruption of daily activities, interrupted sleep, and a general inability to engage fully in life.3 More critically, it poses a serious health risk by often leading to complications such as iron-deficiency anemia.3 Therefore, identifying these signs promptly is the essential first step toward seeking appropriate medical evaluation and initiating effective management of the condition.
Defining Heavy Menstrual Bleeding (Menorrhagia): What’s Normal, What’s Not?
Distinguishing between a normal menstrual period and heavy menstrual bleeding (menorrhagia) involves both objective clinical measurements and an assessment of the condition’s impact on daily life. Medical guidelines provide clear quantitative benchmarks to define menorrhagia, offering a framework for diagnosis.
Clinical Definitions: Quantitative Measures
Menorrhagia is clinically defined as monthly blood loss that exceeds 80 milliliters (ml) or bleeding that lasts greater than 7 days.1 This stands in stark contrast to the average blood loss of 35 to 40 ml over a duration of four to eight days in a typical menstrual cycle.2 The consistent emphasis across various medical guidelines on periods lasting longer than 7 days as a marker for heavy bleeding provides a clear and easily trackable objective measure.3 While precisely measuring blood volume (80ml) can be challenging for an individual at home, the duration of bleeding offers a practical and accessible metric for self-assessment. This dual definition is critical because it accounts for variations in bleeding patterns; some individuals may experience a very heavy but shorter period, while others may have a moderately heavy but significantly prolonged period. Both presentations meet the criteria for menorrhagia. This comprehensive approach ensures that various manifestations of excessive bleeding are recognized, moving beyond subjective feelings to objective clinical criteria.
Qualitative Indicators: How It Impacts Daily Life
Beyond strict quantitative measures, the impact of heavy bleeding on an individual’s daily life and overall well-being serves as a vital qualitative indicator. Heavy menstrual bleeding is also characterized by its severity, to the extent that it becomes unmanageable with regular sanitary products, significantly disrupts daily routines, or interferes with sleep.3 This qualitative aspect is as important as, if not more immediately apparent than, the quantitative thresholds. An individual might not be able to quantify their exact blood loss, but they are acutely aware if their period is “restricting daily activities” or “interrupting sleep”.5 This emphasis on functional impairment and distress highlights that medical attention is warranted not solely based on clinical thresholds but also due to the profound impact the condition has on an individual’s quality of life. This perspective validates the subjective experience of those affected, making it clear that their lived reality is a legitimate reason to seek professional medical evaluation.
Key Signs You’re Losing Too Much Blood During Your Period
Recognizing the specific signs of excessive menstrual bleeding is crucial for identifying when to seek medical advice. These signs often combine observations about the volume and duration of flow with its practical implications and systemic effects on the body.
Excessive Flow and Frequency
One of the most immediate and observable indicators of heavy menstrual bleeding is the rapid saturation of sanitary products. This manifests as needing to change a pad or tampon after less than 2 hours 3, or even as frequently as every hour for several consecutive hours.3 Such a rapid rate of saturation indicates a flow volume that far exceeds the normal absorption capacity of standard menstrual products.
Furthermore, the need for “double protection”—such as using both a pad and a tampon simultaneously, or layering multiple pads—to manage the menstrual flow is a clear indication of bleeding that is unmanageable with typical means.3 This scenario often points to a volume of blood that the body is shedding too quickly for conventional methods to contain.
Another significant sign is waking up during the night specifically to change pads or tampons due to heavy flow.3 This suggests a volume of bleeding that cannot be adequately handled by normal overnight protection, leading to disruption of sleep patterns. These collective signs are often referred to as “flooding” 7, a key qualitative descriptor of heavy menstrual bleeding. The consistency across multiple sources regarding these specific scenarios (hourly changes, double protection, nighttime changes) underscores their reliability as critical flags for self-monitoring. These are not just isolated observations; they form a recognizable pattern of unmanageable flow that is clinically acknowledged as “flooding,” which is a strong predictor of menorrhagia. This helps individuals connect their personal observations to a recognized medical pattern.
Prolonged Bleeding
Beyond the sheer volume of flow, the duration of menstrual bleeding is another critical indicator. Menstrual periods that consistently last longer than 7 days are considered prolonged and are a strong sign of heavy menstrual bleeding.3 While a normal period can extend up to 8 days, a consistent pattern of exceeding this duration, particularly beyond 7 days, strongly suggests menorrhagia.1 This duration criterion offers a straightforward, objective measure that individuals can easily track using a calendar or a period-tracking application. It provides a clear binary indicator—under or over 7 days—that helps differentiate normal variations in menstrual length from a potential underlying problem, even if the perceived flow volume might be moderate. This objective metric is particularly valuable for prompting further investigation.
Large Blood Clots
The presence and size of blood clots during menstruation are highly indicative of excessive blood loss. Passing blood clots the size of a quarter 3 or larger 6, or even larger than a 50-cent piece 7, is a significant warning sign. The observation of “large clumps” in period blood is also noted as a key indicator.4 The use of common coin sizes (quarter, 50-cent piece) provides a tangible and relatable benchmark for what constitutes a “large” clot, making this information highly practical for self-assessment. The formation of such large clots suggests that the body’s natural anticoagulant mechanisms, which normally break down blood clots, are overwhelmed by the sheer volume and speed of bleeding. This indicates a significant issue with the amount of blood being shed, as the blood is flowing too rapidly for the body’s usual processes to manage it effectively.
Impact on Daily Activities
A crucial qualitative indicator of heavy menstrual bleeding is its profound impact on an individual’s daily life and routine. When heavy menstrual flow prevents an individual from engaging in their normal activities, or significantly restricts their daily functioning 3, it signals a problem that extends beyond mere inconvenience. This can include having to miss work, school, or social engagements due to the severity of the bleeding or its associated symptoms, such as pain or fatigue. This sign underscores the functional impairment and reduced quality of life associated with menorrhagia. It shifts the focus from purely physiological symptoms to the broader implications for an individual’s well-being and ability to participate in their usual life, emphasizing that medical intervention is warranted even if quantitative measures of bleeding might seem ambiguous to the individual. The subjective experience of significant disruption is a valid and compelling reason to seek professional help.
Systemic Symptoms Indicating Blood Loss (Anemia)
One of the most serious complications of chronic, excessive blood loss during menstruation is the development of iron deficiency and, subsequently, iron-deficiency anemia.3 Anemia occurs when the body lacks a sufficient number of healthy red blood cells, which are crucial for carrying oxygen to the body’s tissues and organs.4 When the body loses more iron than it can absorb or replace, its ability to produce these oxygen-carrying cells is compromised.
The systemic symptoms of anemia that often accompany heavy periods include:
Persistent tiredness, fatigue, and a general lack of energy: This is a common and often debilitating symptom, as the body’s cells are not receiving enough oxygen to function optimally.3
Feeling weak or dizzy: Reduced oxygen delivery to the brain and muscles can lead to sensations of weakness and lightheadedness.4 In severe cases, this can progress to feeling faint or even losing consciousness, which warrants immediate emergency medical attention.10
Shortness of breath: The body attempts to compensate for reduced oxygen-carrying capacity by increasing breathing rate, leading to a feeling of breathlessness, especially during physical exertion.3
Looking pale: A noticeable paleness of the skin, particularly in the face and inside the lower eyelids, can be a visual sign of reduced red blood cell count.7
The direct link between heavy bleeding and anemia represents a critical cause-and-effect relationship. Recognizing these systemic symptoms is vital because they indicate a more severe, body-wide impact of ongoing blood loss. These symptoms often necessitate immediate medical attention, not just to address the bleeding itself, but also to treat the underlying iron deficiency, which typically involves iron supplementation.3 For many individuals, these systemic effects are the most debilitating aspect of heavy periods, often more so than the bleeding itself, underscoring the importance of addressing this complication proactively.
Associated Pain and Irregularity
While the primary focus of heavy menstrual bleeding is on the volume and duration of flow, other associated symptoms and patterns can also indicate an underlying issue.
Constant Pain or Severe Cramping: Menstrual pain, or dysmenorrhea, is a common experience, but constant pain in the lower abdomen during periods 3 or unusually severe cramping 4 can be associated with heavy bleeding. This is particularly true if the heavy bleeding is caused by conditions such as uterine fibroids, adenomyosis, or endometriosis, which can lead to increased uterine contractions or inflammation. The presence of persistent or unusually intense pain alongside heavy flow warrants medical evaluation to identify the root cause.
Bleeding or Spotting Between Menstrual Periods (Menometrorrhagia): While menorrhagia specifically refers to heavy bleeding during the expected menstrual period, any bleeding or spotting that occurs between periods 6 or unusually long periods 8 falls under the broader category of “abnormal uterine bleeding” (menometrorrhagia). This indicates that the bleeding pattern itself is irregular and unpredictable, which is a significant red flag requiring investigation.8 The inclusion of intermenstrual bleeding broadens the diagnostic scope beyond just heavy flow, suggesting that the overall pattern and associated symptoms of bleeding are as important as the volume. Intermenstrual bleeding, in particular, is a strong indicator for further investigation, including potential biopsy, especially in certain age groups (e.g., above 40 or 45 years) 1, as it can signify a higher risk of underlying pathology, including, though rarely, certain cancers.8 This emphasizes that heavy bleeding might not occur in isolation but could be part of a more complex pattern of abnormal bleeding that necessitates a comprehensive diagnostic approach.
To provide a clear summary of these indicators, the following table outlines the key signs of heavy menstrual bleeding:
Category
Specific Signs
Excessive Flow & Frequency
– Soaking through one or more pads/tampons every hour for several hours in a row 3
– Needing to change a pad or tampon after less than 2 hours 3
– Requiring double protection (e.g., pad and tampon simultaneously) to control flow 3
– Needing to change pads or tampons during the night 3
Prolonged Bleeding
– Menstrual periods lasting longer than 7 days 3
Large Blood Clots
– Passing blood clots the size of a quarter or larger 3
– Passing blood clots larger than a 50-cent piece 7
– Presence of “large clumps” in period blood 4
Impact on Daily Life
– Heavy menstrual flow that restricts or prevents normal daily activities 3
– Disruption of daily routines or interruption of sleep due to bleeding 5
Systemic Symptoms (Anemia)
– Persistent tiredness, fatigue, or lack of energy 3
– Feeling weak or dizzy 4
– Shortness of breath 3
– Looking pale 7
Associated Pain & Irregularity
– Constant pain in the lower part of the stomach during periods 3
– Severe cramping 4
– Bleeding or spotting between menstrual periods 6
– Inconsistent or unpredictable menstrual cycles 8
What Causes Heavy Menstrual Bleeding?
Heavy menstrual bleeding is not a disease in itself but rather a symptom that can stem from a variety of underlying causes. For many individuals, a clear cause may not be immediately identifiable.3 However, a thorough medical evaluation can often pinpoint specific conditions contributing to the excessive blood loss. Understanding these potential causes is crucial for effective diagnosis and treatment.
Hormonal Imbalances and Ovulatory Dysfunction
One of the most common culprits behind heavy periods is an imbalance in the hormones that regulate the menstrual cycle, primarily estrogen and progesterone.4 When these hormones are out of sync, it can lead to an excessive thickening of the uterine lining (endometrium). When this unusually thick lining eventually sheds, it results in a heavier and often more prolonged menstrual flow.4 This is particularly prevalent during periods of significant hormonal transition, such as the years immediately following menarche (when periods first begin) and during perimenopause (the transition to menopause, typically after age 40).1 During these times, anovulatory cycles—cycles where an egg is not released—are more common, leading to irregular hormonal patterns that can contribute to heavy bleeding.1 The menstrual cycle relies on a delicate hormonal “symphony,” and any disruption to this balance can manifest as abnormal uterine bleeding.8
Uterine-Related Problems
Structural abnormalities or growths within the uterus are frequent causes of menorrhagia. These include:
Uterine Fibroids: These are non-cancerous (benign) growths that develop in the muscular wall of the uterus.3 Their size, number, and location can significantly impact menstrual flow, often leading to heavier and more painful periods.
Endometrial Polyps: These are typically benign growths that extend from the lining of the uterus (endometrium) into the uterine cavity.3 They can cause irregular or heavy bleeding.
Adenomyosis: This condition occurs when the tissue that normally lines the uterus (endometrium) grows into the muscular walls of the uterus.5 This misplaced tissue thickens, breaks down, and bleeds during each menstrual cycle, leading to significantly heavy and painful periods.
Endometrial Hyperplasia: This refers to an excessive thickening of the uterine lining, which can be caused by hormonal imbalances (too much estrogen without enough progesterone) and can lead to heavy bleeding.7
Endometriosis: While often associated with severe pain, endometriosis, where uterine-like tissue grows outside the uterus, can also contribute to heavy periods.4
Intrauterine Devices (IUDs): Certain types of birth control, particularly copper IUDs, can make periods heavier for some individuals.3 This is thought to be due to the coil causing slight inflammation of the uterine lining and irritating small blood vessels.4 Hormonal IUDs can also cause heavier periods initially after insertion.4
Uterine or Cervical Cancer: While rare, malignant growths in the uterus or cervix can also be a cause of heavy periods.3 This possibility underscores the importance of thorough diagnostic evaluation, especially in individuals with risk factors or persistent symptoms.
Adhesions or Inflammations: Bands of tissue (adhesions) or inflammations within the womb or fallopian tubes, whether present from birth or resulting from surgery or severe endometriosis, can also contribute to abnormal bleeding patterns.4
Bleeding Disorders
In some cases, heavy menstrual bleeding can be a manifestation of an underlying bleeding disorder, where the blood does not clot properly. These are particularly suggested if heavy bleeding is accompanied by “flooding” or prolonged menses, or if there is a personal or family history of bleeding issues.9 Common bleeding disorders include:
Von Willebrand Disease (VWD): This is an inherited bleeding disorder where the blood lacks or has a defective von Willebrand factor, a protein necessary for normal blood clotting.3
Platelet Function Disorders: These involve issues with platelets, small blood cells crucial for forming clots.3
Other Inherited Bleeding Disorders: Various other genetic conditions can impair the body’s ability to stop bleeding effectively.3
If a bleeding disorder is suspected, a referral to a hematologist (a blood disorder specialist) may be warranted.9 This clear diagnostic pathway highlights that heavy menstrual bleeding is not solely a gynecological issue but can be a systemic problem requiring specialized evaluation.
Other Medical Conditions and Medications
Less commonly, heavy periods can be a symptom of other systemic medical conditions or a side effect of certain medications:
Hormonal Disorders: Beyond direct ovarian dysfunction, conditions affecting the thyroid gland (e.g., hypothyroidism) or pituitary gland (affecting prolactin levels) can disrupt menstrual regularity and lead to heavy bleeding.1
Liver or Kidney Disease: Impaired liver or kidney function can affect hormone metabolism and blood clotting, potentially leading to heavy periods.4
Pregnancy Complications: In some instances, bleeding during pregnancy, even if light, can be a sign of complications.5
Medications: Certain medications, particularly anticoagulants (blood thinners), can increase menstrual flow.9 It is also important to note that while NSAIDs can help reduce bleeding, aspirin and medications containing aspirin can actually increase bleeding and should be avoided for heavy periods.4
The diverse range of potential causes for heavy menstrual bleeding underscores the importance of a comprehensive diagnostic approach. When common gynecological causes are ruled out, systemic issues, including bleeding disorders, should be thoroughly investigated. The fact that a significant percentage of women (30%) seek medical assistance for HMB 1, and that intrauterine abnormalities are detected in a notable proportion of these cases (42.5%) via hysteroscopy 1, highlights the clinical significance of these underlying pathologies and the need for thorough diagnostic pathways.
When to Seek Medical Attention
Recognizing the signs of heavy menstrual bleeding is the first step, but knowing when to seek professional medical attention is equally crucial. While some individuals may manage heavy periods without treatment, medical consultation is strongly recommended if the bleeding significantly impacts daily life or leads to health complications.4
When to Consult a Healthcare Provider
It is advisable to schedule an appointment with a healthcare provider if any of the following signs are consistently present during your period 3:
Rapid Soaking of Products: If there is a need to change a pad or tampon after less than 2 hours, or if products are soaked through every hour for several hours in a row.3
Prolonged Bleeding: If menstrual periods consistently last longer than 7 days.3
Large Blood Clots: If blood clots the size of a quarter or larger are frequently passed.3
Disruption to Daily Life: If heavy menstrual flow prevents participation in normal activities, disrupts sleep, or causes significant distress.3 This emphasizes that the functional impairment experienced by the individual is a valid and important reason to seek medical help.
Signs of Anemia: If symptoms such as persistent tiredness, fatigue, weakness, dizziness, or shortness of breath accompany heavy periods.3 These symptoms are particularly important as they indicate a systemic impact of blood loss and often require intervention beyond just managing the bleeding.
Bleeding Between Periods: Any spotting or bleeding that occurs outside of the regular menstrual period warrants investigation.6
Constant or Severe Pain: While not directly a sign of blood loss, severe or constant lower abdominal pain during periods can be associated with underlying conditions causing heavy bleeding.3
It is helpful to keep a detailed record of your period for several weeks before your appointment, noting the start and end dates, the heaviness of the flow, the number of pads and tampons used (and if they were soaked), and any other accompanying symptoms.5 This information provides invaluable data for your healthcare provider to accurately assess your condition.
When to Seek Emergency Medical Attention
Certain symptoms indicate a more severe situation requiring immediate medical care. Seek emergency medical attention if you experience any of the following 10:
Difficulty Breathing: This can be a sign of severe anemia or other serious complications, indicating that the body is struggling to get enough oxygen.
Passing Very Large Clots: While large clots are a general sign of heavy bleeding, exceptionally large or numerous clots, especially if accompanied by other severe symptoms, warrant urgent evaluation.
Feeling Faint or Unexpectedly Losing Consciousness: These are critical signs of significant blood loss and potential shock, requiring immediate medical intervention to prevent further complications.
These emergency signs are vital for immediate action, as they point to acute blood loss that could lead to life-threatening complications.
Diagnosis and Treatment Approaches
Once an individual seeks medical attention for heavy menstrual bleeding, a comprehensive diagnostic process is initiated to identify the underlying cause. This is followed by a tailored treatment plan.
Diagnostic Methods
Diagnosis typically begins with a thorough medical history, where the healthcare provider will ask detailed questions about bleeding patterns, duration, frequency, and associated symptoms.5 It is beneficial for the individual to have tracked their menstrual cycles, including flow intensity and product usage, prior to this discussion.5 This patient-reported data is a crucial starting point for the clinical assessment. A physical examination, including a pelvic exam and often a Pap test, will also be conducted.5
Further diagnostic tests may include:
Blood Tests: These are essential to check for anemia (complete blood count or CBC), assess thyroid function, evaluate hormone levels (e.g., TSH, prolactin, androgens), and investigate blood clotting abnormalities.3 A pregnancy test is also routinely performed to rule out pregnancy-related bleeding.5 These tests help to uncover systemic causes or complications of heavy bleeding.
Pelvic Ultrasound: This non-invasive imaging technique uses sound waves to visualize the uterus, ovaries, and other reproductive organs, helping to identify structural issues like fibroids, polyps, or adenomyosis.3 A sonohysterogram (saline-infusion sonography) can provide more detailed images of the uterine cavity.8
Endometrial Biopsy: In this procedure, tissue samples are collected from the lining of the uterus (endometrium) to check for abnormal cells, hyperplasia, or cancer.3 This is particularly recommended for individuals over 40 or 45 years of age, or those with intermenstrual bleeding or other risk factors.1 This targeted tissue sampling is crucial for ruling out malignancy.
Hysteroscopy: Considered the “gold standard” for evaluating the uterine cavity, hysteroscopy involves inserting a thin, lighted telescope through the cervix into the uterus, allowing direct visualization of the uterine lining.1 This procedure enables precise identification of lesions like fibroids or polyps, assessing their nature, size, shape, location, and vascular pattern, and allows for targeted tissue sampling.1 It is particularly valuable as it can detect intrauterine abnormalities that might be missed by routine ultrasound.1 The fact that hysteroscopy detects abnormalities in a significant percentage of HMB cases (42.5%) underscores its importance in a comprehensive diagnostic pathway.1 This demonstrates that while initial imaging is helpful, direct visualization and biopsy may be necessary for a definitive diagnosis, especially given the high rate of detected abnormalities.
The goal of this comprehensive work-up is to determine whether the heavy bleeding is due to a uterine/endometrial abnormality, a disorder of ovulation, or a disorder of coagulation.9 If a bleeding disorder is suspected based on history or initial tests, a referral to a hematologist may be necessary.9 This multidisciplinary approach ensures that all potential causes, whether gynecological or systemic, are thoroughly investigated.
General Treatment Approaches
Treatment for heavy menstrual bleeding is highly individualized, depending on the identified cause, the severity of symptoms, the individual’s age, overall health, and crucially, their desire for future pregnancy.4
1. Lifestyle and Dietary Adjustments:
Hydration: Drinking ample water (4 to 6 extra cups during heavy bleeding) helps maintain blood volume. Adding a sprinkle of salt or electrolytes can help balance fluid levels.10
Iron-Rich Diet: Prioritizing iron-rich foods is essential to combat iron deficiency and anemia caused by blood loss. Examples include shellfish, spinach, liver, legumes, red meats, pumpkin seeds, and quinoa.10 Cooking in cast-iron pots can also increase iron intake.10
Vitamin C Intake: Increasing vitamin C consumption (e.g., from Kakadu plums, acerola cherries, green chili peppers) aids in iron absorption and may help reduce bleeding.10
Blackstrap Molasses: This can be a good source of iron and other vital nutrients.10
Iron Supplements: If anemia is diagnosed, iron supplements are often prescribed to replenish iron stores and help the body produce healthy red blood cells.3 These dietary and supplemental strategies are crucial for addressing the systemic consequences of heavy bleeding.
2. Medical Treatment (Medications):
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Medications like ibuprofen (Advil) and naproxen (Aleve) can help reduce cramping and significantly decrease the amount of blood loss by inhibiting prostaglandins, which are involved in uterine contractions and bleeding.4 It is crucial to avoid aspirin and medications containing aspirin, as they can increase bleeding.4 This specific caution about aspirin is a critical safety point for individuals managing heavy periods.
Antifibrinolytic Drugs: Medications such as tranexamic acid (TXA) work by preventing blood clots from breaking down too quickly, thereby reducing menstrual bleeding.4 These offer a non-hormonal option for managing acute bleeding.
Hormonal Therapies: These are widely used to regulate or reduce heavy bleeding by thinning the uterine lining and often suppressing ovulation. Options include:
Combined Hormonal Contraceptives: Birth control pills, patches, or vaginal rings containing both estrogen and progestin can effectively reduce menstrual flow and cramping.4 They can be used in extended or continuous regimens to further minimize bleeding episodes.9
Progestin-Only Contraceptives: These include progestin-only pills, injections (e.g., DMPA), implants, or hormonal intrauterine devices (IUDs) that release levonorgestrel.4 Hormonal IUDs are particularly effective at reducing bleeding and can prevent pregnancy for several years.9 Progestin tablets can also be used as a stand-alone treatment to thin the uterine lining.4
Gonadotropin-Releasing Hormone (GnRH) Therapies: These medications (agonists or antagonists) temporarily reduce estrogen levels, preventing the uterine lining from thickening and shedding. They are often used for short-term relief, sometimes before surgery, and can also help shrink fibroids.10 They are typically prescribed with hormone “add-back” therapy to mitigate side effects.10 The detailed list of hormonal treatments highlights that management is highly individualized, depending on factors such as the desire for contraception and the duration of treatment required.
3. Non-Surgical Procedures and Surgical Operations:
These options are generally considered for more severe cases, or when other treatments have been ineffective, and are significantly influenced by the individual’s desire for future pregnancy.4
High-Intensity Focused Ultrasound (HIFU): A minimally invasive procedure that uses targeted sound waves to destroy uterine fibroid tissue with heat, addressing fibroid-induced bleeding.10
Uterine Artery Embolization (UAE): A minimally invasive procedure for fibroid-related bleeding, where small particles are injected to block blood supply to fibroids, causing them to shrink.10
Myomectomy: A minimally invasive surgical procedure to remove uterine fibroids while preserving the uterus, making it an option for those who wish to maintain fertility.10
Endometrial Ablation or Resection: These minimally invasive procedures involve destroying or removing the lining of the uterus.4 While highly effective at reducing or stopping bleeding, pregnancy is highly unlikely, though not impossible, afterward.4
Hysterectomy: This is a major surgical procedure involving the removal of the entire uterus.4 It is typically considered as a last resort for very severe cases that significantly impact quality of life, especially when other treatments have failed and the individual does not desire future pregnancies, as pregnancy is no longer possible after this procedure.4
The decision-making process for treatment involves a careful consideration of the cause of heavy periods, the individual’s specific symptoms, their lifestyle, and their reproductive goals. Open communication with a healthcare provider is essential to explore all available options and determine the most suitable care plan.
