Heavy Menstrual Bleeding: Causes, Symptoms, and Treatment Options

Heavy menstrual bleeding is one of the most common reasons a woman visits a gynecology clinic. Despite being common, it is often ignored or normalized, even though it can significantly affect a woman’s quality of life. In this blog, let’s understand what heavy menstrual bleeding is, why it occurs, how it is evaluated, and the available treatment options.

What Is Normal Menstrual Bleeding?

A normal menstrual cycle usually occurs once every month and lasts for about 3 to 5 days. During this time, bleeding is manageable and does not interfere with daily activities.

What Is Heavy or Abnormal Menstrual Bleeding?

By definition, blood loss of more than 80 ml per cycle is considered abnormal. However, there is no practical test to measure the exact amount of menstrual blood loss, so heavy menstrual bleeding is often identified based on symptoms.

Heavy or prolonged menstrual bleeding may be suspected if:

• You need to change a pad or tampon every 1–2 hours

• There is passage of blood clots

• There is flooding, where blood soaks through pads onto clothes or bedsheets

• Bleeding lasts for more than 7 days

• Menstrual bleeding disrupts daily life, work, or social activities

Simply put, if your periods affect your quality of life, it is considered heavy menstrual bleeding and needs medical attention.

Causes of Heavy Menstrual Bleeding

Heavy menstrual bleeding can occur due to several reasons, which are broadly classified into structural, hormonal, medical, and rarely malignant causes.

1. Structural Causes

These involve growths inside the uterus:

• Fibroids – benign growths arising from the muscle of the uterus

• Polyps – small growths arising from the lining of the uterus

These growths interfere with normal shedding of the uterine lining and lead to heavy periods.

2. Hormonal Imbalance

The uterine lining normally thickens and sheds every month. If the lining becomes too thick or too thin, often due to hormonal imbalance, it can cause abnormal or heavy bleeding.

3. Medical Disorders

Certain medical conditions can also cause heavy menstrual bleeding, such as:

• Thyroid disorders

• Use of blood-thinning medications

• Other systemic illnesses

4. Rare Causes

In rare cases, uterine or endometrial cancer can present as heavy or irregular menstrual bleeding and must be ruled out.

What to Expect When You Visit a Gynecologist

When you consult a gynecologist for heavy menstrual bleeding, the evaluation usually includes:

• Detailed menstrual history

• Enquiry about existing medical conditions (e.g., thyroid disease)

• Abdominal and pelvic examination

• Blood tests to check hemoglobin levels and thyroid function

• Ultrasound scan to assess:

  • Fibroids or polyps

  • Thickness of the uterine lining

These investigations help confirm the cause and guide treatment.

Treatment Options for Heavy Menstrual Bleeding

Treatment depends on:

• The cause of bleeding

• The age of the woman

• Desire for future fertility

• Severity of symptoms

1. Medical Management

This is usually the first line of treatment.

• Tranexamic acid or NSAIDs: Help reduce bleeding by affecting clotting mechanisms
  Nearly 50% of women improve with medications alone

• Hormonal treatment:

  • Combined oral contraceptive pills

  • Hormone-releasing intrauterine device (IUD), which controls the uterine lining and reduces bleeding

2. Surgical Management

If medical treatment fails or if structural causes are present:

• Polyp removal using hysteroscopy (a camera is inserted into the uterus to remove the polyp)

• Fibroid surgery:

  • Myomectomy – removal of only the fibroid

  • Hysterectomy – removal of the uterus (considered based on age and fertility wishes)

Treatment is always individualized based on patient needs.

Final Thoughts on Women’s Health

Heavy menstrual bleeding is not something to ignore or normalize. A woman is the heart of her family, and women’s health is of utmost importance, though often neglected. Early evaluation and timely treatment can greatly improve health, confidence, and quality of life. If you are experiencing heavy periods, this information can help you have a meaningful discussion with your doctor and seek the care you deserve.