If you’re like most women, you’ve experienced heavy or irregular menstrual bleeding.
At best, it’s a nuisance, with painful cramps and bloating that make that time of the month much more annoying. At worst, it could be a symptom of a more serious condition, such as endometrosis or fibroids.
With a little insight into your own cycle, you can figure out whether heavy bleeding is reason to run to a doctor, or if you should just stay in your “period panties.”
Know Your Flow
Every woman is unique. So to understand what’s abnormal, you first have to know your normal menstrual cycle. Then you can determine why you’re bleeding is heavier than usual.
Most periods last 3-7 days and occur every 21-35 days. To measure the length of yours, count from the first day of bleeding to the last during each cycle.
To determine its frequency, count from the first day of bleeding in one cycle through the first day of bleeding in the next. Keep track of them in your calendar and eventually you should see a pattern in both numbers.
A day or two variation is nothing to worry about, but any bigger differences in cycle length or frequency are reasons to see your doctor, says Colleen Stockdale, M.D., assistant professor of obstetrics & gynecology at the University of Iowa.
A normal flow is trickier to measure. What’s heavy to one woman can be light to another.
A “heavy flow” is defined as more than 3-4 tablespoons of blood, which obviously is difficult to measure.
Fortunately, we have the Mansfield-Voda-Jorgensen Menstrual Bleeding Scale, which was created as part of a research project that has been tracking thousands of women’s menstrual cycles for more than 70 years. The six-point scale helps accurately determine flow based on the use of pads and tampons:
1. Spotting. A drop or two of blood, not even requiring sanitary protection, though you may prefer to use some.
2. Very Light Bleeding. Needing to change a low-absorbency tampon or pad 1-2 times per day.
3. Light Bleeding. Needing to change a low- or regular-absorbency tampon or pad 2-3 times per day.
4. Moderate Bleeding. Needing to change a regular-absorbency tampon or pad every 3-4 hours.
5. Heavy Bleeding. Needing to change a high-absorbency tampon or pad every 3-4 hours.
6. Very Heavy Bleeding or Gushing. Protection hardly works; you would need to change the highest absorbency tampon or pad every 1-2 hours.
If you soak through more than one pad or tampon every hour for 2-3 hours straight, call your doctor or head to an emergency room.
But just because your menstrual flow falls into the heavy-bleeding category doesn’t mean that something’s wrong. Some women just have heavier flows than others.
Bleeding to Worry About
Many problems can cause heavy periods, Stockdale says. Sometimes, it’s simply age, a change in contraception or life-stage that’s to blame. For example, some women who’ve had several children find that their periods get heavier because of structural changes to the uterus that doctors don’t entirely understand.
A sudden change in flow is what you need to watch for: If you don’t normally bleed heavily and suddenly start, or if you start bleeding between cycles, see your doctor.
It can be a sign of a another problem, says Stephanie McClellan, M.D., founder of the Doctors Office for Women, including:
* Uterine polyps or fibroids. Both are usually benign growths that occur inside the uterus and cause bleeding.
* Cervical polyps or precancerous changes to the cells of the cervix.
* Common sexually transmitted infections (STIs), such as gonorrhea and chlamydia. If left untreated, both can lead to bleeding.
* A yeast or bacterial infection. Untreated, these vaginal illnesses can cause bleeding.
* Medical conditions that affect reproductive organs, such as endometriosis (see below).
* General medical conditions, such as von Willebrand’s disease, a bleeding disorder, and thyroid disease.
* Obesity, diabetes and hypertension. Women who are overweight or have diabetes or hypertension are at higher risk for uterine hyperplasia – the abnormal thickening of the uterine lining.
* Cancer. More rare, irregular menstrual bleeding can be the result of cancer.
Getting a Diagnosis
The first step to determine what’s causing heavy bleeding is an exam by your ob/gyn to check out your anatomy.
Your doctor will be able to tell quickly if your uterus is larger than normal or has any lumps or other telltale trouble signs. An ultrasound may be done to check for fibroids or polyps.