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Heavy Menstrual Bleeding  

What causes heavy menstrual bleeding?

Heavy menstrual bleeding is common.[1,2] Most women have had at least one menstrual period in which heavy bleeding occurred. An estimated 3 out of 10 pre-menopausal women experience recurrent heavy menstrual bleeding. Some women are at higher risk for heavy menstrual bleeding, due to the following risk factors:

• Presence of hereditary bleeding disorders in which the ability of the blood to clot is lessened
• Age, such as during early adolescence and peri-menopause (the time preceding complete menopause)

As women’s perception of what constitutes a heavy period may vary, healthcare professionals diagnose medically heavy menstrual bleeding (called menorrhagia or hypermenorrhea by physicians) by the following signs and symptoms:[1, 2]

• Requiring wearing both a tampon and a sanitary pad for protection
• Requiring a change of tampon or sanitary pad each hour or every two hours for a duration of several continuous hours
• Requiring a change of tampon or sanitary pad during the middle of the night
• Experiencing sudden flow of blood that soaks the tampon, sanitary pad, or clothes
• Containing large clots of blood
• Resulting in a monthly loss of menstrual blood that is greater than the normal range of 4 tablespoons to 1 cup
• Lasting longer than 7 days
• Associated with lower abdominal pain that is constant at the time of the menstrual period
• Associated with irregular timing of menstrual period
• Causing symptoms of anemia such as feeling tired or fatigued or experiencing shortness of breath
• Interfering with the woman’s usual activities

If you experience any of the following conditions, note the number of sanitary pads and tampons used and consult your physician for proper diagnosis (involving a physical examination and a blood test, iron test, Pap test, and/or other tests) and treatment:[2]

• Heavy menstrual bleeding, menorrhagia, or severe menstrual pain in pre-menopausal women

• Vaginal bleeding in post-menopausal women who either are not taking HRT or are taking HRT in a non-cyclic manner

Heavy menstrual bleeding and menorrhagia may be caused by a variety of factors. Approximately 80% of cases of menorrhagia are caused by:[1-3]

• Imbalance of the hormones estrogen and progesterone, which can lead to an over-buildup of the endometrium, the lining of the uterus. Excessive buildup of the endometrium is shed during the menstrual period. Hormonal imbalance may occur at certain ages such as adolescence and peri-menopause, may result from incorrect use of hormonal medications, or be caused by diseases of the thyroid.

• Presence of fibroids, which are benign (non-cancerous) tumors of the uterus

Less common causes of menorrhagia include:[2, 3]

• Medications, including anti-inflammatory medicines, anticoagulants (i.e., medicines that block the clotting of blood), and certain chemotherapy drugs
• Use of intra-uterine devices (IUDs) for birth control
• Complications of pregnancy, including miscarriage and ectopic pregnancy (i.e., the development of a fertilized egg inside the fallopian tube, rather than in the uterus)
• Ovarian cysts, which are present on or inside the ovary. These sacs of tissue containing fluid usually are benign (i.e., non-cancerous). In rare cases, ovarian cysts cause menorrhagia.
• Dysfunction of the ovaries. If the ovaries do not make or do not release mature eggs, an imbalance of hormones may occur, which can lead to menorrhagia.
• Uterine polyps, which are benign tumors on the wall of the uterus. These growths, which are caused by overproduction of hormones or taking too high a level of hormonal medication, may result in menorrhagia and spotting (i.e., light bleeding between periods).
• Adenomyosis, a condition in which glands in the lining (endometrium) of the uterus become stuck inside the muscle of the uterus and can result in menorrhagia and pain.
• Other non-cancerous medical conditions, including pelvic inflammatory disease (PID), endometriosis, lupus, liver disease, kidney disease, low function of the thyroid gland, and some rare disorders of the blood
• Cancer of the cervix, uterus, and ovaries, all of which are rare causes of menorrhagia

Possible complications of prolonged bleeding during menstruation or menorrhagia include:[2]

• Iron deficiency anemia, a condition in which the blood has too low a level of iron and too low an amount of healthy red blood cells. Signs and symptoms are weakness, fatigue, lightheadedness, headaches, being mentally confused, irritability, ringing in the ears, pale skin, shortness of breath, an abnormally fast heart rate, and restless legs syndrome. If a patient with prolonged anemia or severe anemia is not treated, heart problems may result.
• Severe menstrual pain (i.e., severe menstrual cramps), which also is called severe dysmenorrhea
• Lack of fertility (i.e., inability to become pregnant or to give birth to a child), due to certain causes of the menstrual abnormalities and irregularity
• Toxic shock syndrome (TSS), a condition that can be caused by bacterial infections resulting from keeping the same tampon in place for greater than 8 hours. Although a rare condition, TSS may be life-threatening. Signs and symptoms of TSS include extremely high fever, very low blood pressure, severe fatigue, skin rash, sore throat, and diarrhea.

Regardless of whether or not you experience heavy menstrual bleeding, menorrhagia, or irregular periods, preventative gynecology care for adult women and sexually active adolescents includes annual pelvic examinations and Pap tests by a gynecologist or other physician.[2]

Fortunately, many treatment options are available for women with heavy menstrual bleeding and menorrhagia. See our Q&A, called Treatment of Heavy Menstrual Bleeding, for a discussion of self-care, naturopathic approaches, homeopathic remedies, and medical therapies that may be used to manage and help reduce heavy menstrual bleeding and menorrhagia.

Bleeding between menstrual periods may result from a variety of causes. If you experience bleeding between periods, note when the bleeding occurs during the month, and consult your integrative medical physician and gynecologist for proper diagnosis and guidance on treatment.[2]


1. Consumer Reports. Heavy periods. Accessed at
2. Mayo Clinic. Menorragia (heavy menstrual bleeding). Accessed at
3. I. Ikenze. Menopause & Homeopathy: A Guide for Women in Midlife. 1998. Berkeley, CA: North Atlantic Books

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