Heavy menstrual bleeding: Treatments and more

Most people don't realize that heavy menstrual bleeding isn't something you just "power through." If you're soaking pads or tampons hourly, passing large clots, or bleeding longer than a week, there are proven treatments that can helpoften without surgery.

And yes, it's scary and exhausting. But with the right planchecking for causes like fibroids, thyroid issues, or bleeding disordersand picking treatments that fit your life (and fertility goals), you can get your energy and routine back. Think of this as a practical, judgment-free guide to understanding heavy periods (also called menorrhagia), why they happen, and what actually works to treat them. Ready?

What counts as heavy menstrual bleeding?

Let's start by getting on the same page. "Heavy" can feel subjective, and many of us were taught to tough it out. But heavy menstrual bleeding (HMB) has clear signsand your experience matters.

Quick self-check: do your symptoms match HMB?

You don't need fancy tools to get a first sense. Ask yourself:

• Do you soak through one pad or tampon every hour for at least 2 hours straight?
• Does your period last more than 7 days?
• Do you pass clots that are quarter-sized or larger?
• Do you need to double up (pad + tampon), or wake at night to change?
• Do you feel wiped out, dizzy, or short of breath during your period?

If you're nodding along to a couple of these, it's worth a conversation with a clinician. Trusted sources like the Mayo Clinic, CDC, and Cleveland Clinic describe these signs as consistent with heavy menstrual bleeding.

Heavy bleeding vs "normal" blood loss

Here's the tricky part: most of us don't pour our menstrual blood into measuring cups (understandably!). A typical period is about 23 tablespoons (3040 mL) over the whole cycle. Heavy menstrual bleeding is usually defined as blood loss over 80 mL. Since measuring is tough, practical clues help:

• Needing to change a super tampon or pad every hour or two, repeatedly
• "Flooding" or sudden gushes that soak through clothes or sheets
• Clots bigger than a quarter

Clinics sometimes use pictorial charts to estimate menstrual blood loss. If you're curious, keep a simple log for a couple of cycleshow often you change products, size of clots, any flooding. It's surprisingly helpful during appointments.

When to seek urgent care

There are moments when waiting it out isn't safe. Please seek urgent evaluation if you:

• Soak through one pad or tampon per hour for more than 2 hours
• Feel faint, dizzy, or have a racing heartbeat
• Are pregnant or within six weeks postpartum and have heavy bleeding
• Have any vaginal bleeding after menopause

Heavy bleeding can cause anemia quicklyyour safety comes first.

Common causes

Heavy periods are a symptom, not a character flaw. The "why" can be simple or layered. Here are the most common categories.

Hormonal imbalance and anovulation

Ovulation is like the conductor of your cycle. When it's skipped (anovulation), estrogen may build the uterine lining without the usual balance from progesterone. The lining gets thicker, so when your period starts, there's more to shedhello, heavy bleeding. This is common in:

• PCOS (polycystic ovary syndrome)
• Thyroid problems (both overactive and underactive)
• Perimenopause (your 40s can be a hormonal rollercoaster)

According to resources like the Mayo Clinic and Cleveland Clinic, addressing the underlying hormone imbalance can dramatically improve menstrual blood loss.

Uterine conditions

• Fibroids: Noncancerous muscle tumors in the uterus. Depending on size and location, they can increase surface area inside the uterus or distort the cavity, both of which can ramp up bleeding and cramps.
• Polyps: Small growths on the uterine lining that can cause irregular and heavy bleeding.
• Adenomyosis: Uterine lining cells grow into the muscular wall, often causing heavy, painful periods and a tender, enlarged uterus.

These conditions are common and manageablepromise.

Bleeding and clotting issues

Sometimes the blood itself is part of the story. Inherited bleeding disorders like von Willebrand disease can show up as heavy periods, easy bruising, or prolonged bleeding after dental work. If heavy periods started with your first periods, or there's a family history of bleeding problems, consider asking about a hematology evaluation. The CDC and hematology guidelines note that targeted testing can uncover treatable conditions.

Medications and devices

Blood thinners (anticoagulants), some herbal supplements, and even certain hormones can increase bleeding. Copper IUDs may make periods heavier and crampier, especially in the first months. If a copper IUD worsens bleeding, options include NSAIDs, tranexamic acid during menses, or switching to a levonorgestrel-releasing IUD, which typically lightens periods.

Pregnancy-related and cancer causes

Heavy bleeding can signal miscarriage or ectopic pregnancyboth need prompt care. Less commonly, heavy or irregular bleeding can be a sign of endometrial or cervical cancer, particularly after age 45 or with risk factors. Early evaluation matters because early treatment works best.

Other medical conditions

Liver and kidney disease can affect clotting. Higher body weight can increase estrogen exposure, thickening the uterine lining. Treating the root condition often helps the bleeding too.

How doctors diagnose

Good news: the process is usually straightforward and tailored to you. A compassionate clinician will start with your story and then choose focused tests.

Your story matters

Expect questions like:

• How long do your periods last? How heavy are your heaviest days?
• Do you pass large clots or experience flooding?
• How does bleeding affect work, school, exercise, intimacy, sleep?
• Do cycles come regularly? Any missed periods or surprise spotting?
• Any pregnancies, miscarriages, or birth control changes?
• Family history of heavy periods or bleeding problems?
• Medications and supplements (including aspirin, anticoagulants)?
• Do you want to get pregnant now or in the future?

Your answers shape the planno one-size-fits-all here.

Exams and imaging

• Pelvic exam: Checks for signs of infection, cervical polyps, or other visible causes.
• Ultrasound: First-line imaging to look for fibroids, polyps, or adenomyosis.
• Saline sonohysterogram: A small amount of fluid outlines the uterine cavity, improving detection of polyps or submucosal fibroids.
• Hysteroscopy: A tiny camera views the inside of the uterus; polyps or small fibroids can sometimes be treated at the same time.

According to clinical guidance from hematology and gynecology sources, imaging is chosen based on your symptoms and age, with minimal invasiveness whenever possible.

Lab tests

• CBC and ferritin: Check for anemia and iron storeskey if you're fatigued, lightheaded, or short of breath.
• Pregnancy test: Always part of the safety checklist if there's any chance.
• TSH (thyroid), prolactin, and androgens: Considered if cycles are irregular or suggest a hormonal cause.
• Bleeding studies: If a bleeding disorder is suspected, tests may include von Willebrand factor, platelet function, and others. Timing and interpretation matter, so this is often coordinated with hematology.

Tools to track blood loss

Keeping a menstrual diary for 23 cycles can be game-changing. Track:

• Number and type of pads/tampons/cups used (note how soaked they were)
• Clot size and flooding episodes
• Days you needed to skip activities
• Symptoms like fatigue, dizziness, or cramps

Clinicians sometimes use pictorial scoring systems that translate what you record into an estimate of menstrual blood loss. According to public health resources from the CDC, these tools improve diagnosis and treatment decisions.

Treatment options

Your treatment should match your goals: Do you want birth control? Are you trying to conceive? Do you prefer non-hormonal options? Let's walk through choices from least to most invasive. Most patients start with medications and see significant relief.

First-line medical options

• NSAIDs (like ibuprofen or naproxen): Taken during your period, these can reduce flow by 2040% and ease cramps. They work best when started at the first sign of bleeding. Avoid if you have certain stomach, kidney, or bleeding issues, or if your clinician advises against them.
• Tranexamic acid: A non-hormonal medicine taken only on heavy days. It helps your blood clot at the uterine level and can reduce flow by up to 4060%. Not for everyoneavoid if you have a history of certain clots; check with your clinician.
• Combined hormonal contraceptives (pill, patch, ring): Regulate cycles, lighten bleeding, and reduce cramps. They can be tailored continuously (skipping the placebo week) to reduce periods even further, if appropriate.
• Progestin-only methods: Options include the mini-pill, depot shots, or the levonorgestrel IUD. The levonorgestrel IUD is one of the most effective menorrhagia remedies, often reducing menstrual blood loss by 7090% within 36 months. Many people eventually have very light periods or none at all while it's in place.

Choosing between these depends on your health profile and whether you want contraception. It's okay to try one, check in after a few cycles, and adjust.

Iron and anemia care

If heavy bleeding has drained your iron stores, repletion is just as important as slowing the flow. Oral iron (often every other day to improve absorption and reduce side effects) or, in some cases, IV iron can help you feel human againmore energy, less brain fog, better exercise tolerance. Pairing iron with vitamin C improves absorption.

Targeted treatments for causes

• Fibroids: Medical therapies (like the levonorgestrel IUD, tranexamic acid, combined pills) can help bleeding. If symptoms persist, procedures include uterine-sparing options like myomectomy, uterine artery embolization, or focused ultrasound. The best choice depends on size, location, and pregnancy plans.
• Polyps: Often removed via hysteroscopy in a quick, minimally invasive procedure that can immediately reduce bleeding.
• Adenomyosis: Hormonal options (levonorgestrel IUD, combined methods) are first-line; some find relief with GnRH analogs or, if childbearing is complete and symptoms are severe, hysterectomy.
• Hormonal imbalance/PCOS: Cycle regulation with hormonal therapy, plus addressing insulin resistance, thyroid disorders, or elevated prolactin if present. Lifestyle changes that improve insulin sensitivity can also help improve excessive menstrual bleeding over time.
• Bleeding disorders: Treatments may include tranexamic acid, desmopressin (for certain types of von Willebrand disease), or factor concentrates under hematology guidance.

Procedures and surgery

• Endometrial ablation: Destroys the uterine lining to reduce or stop bleeding. Not for those who wish to conceive in the future, and contraception is still needed afterward because pregnancy can be dangerous post-ablation.
• Myomectomy: Removes fibroids while preserving the uterusoften chosen by people who want pregnancy in the future.
• Uterine artery embolization: Shrinks fibroids by cutting off their blood supply; usually for those not seeking pregnancy.
• Hysterectomy: Definitive cure for uterine bleeding when other options fail or aren't desired. Recovery and risks should be weighed carefully, but for some, it is life-changing.

One size does not fit all. A supportive clinician will walk through benefits, risks, and recovery for each option.

What to try at home (alongside medical care)

• Track your cycle and bleeding patternsknowledge is power and speeds up diagnosis.
• Use the right products for you: menstrual cups can help estimate flow; period underwear is great for backup on heavy days.
• Hydrate and support iron: iron-rich foods (red meat, beans, lentils, leafy greens) plus vitamin C sources can help. If you're iron deficient, supplements may be neededask about dosing and timing.
• Plan for heavy days: schedule lighter activities when you can, stock supplies, and give yourself grace. You're not "weak" for adjusting your life around your healthyou're wise.

Real-life stories

I'll never forget a friend who thought changing a super tampon every hour was just her "normal." She was pale, breathless on stairs, and sleeping 10 hours a night. After a simple workup showed iron-deficiency anemia and fibroids, she tried a levonorgestrel IUD and iron therapy. Three months later, she texted me after her first light period: "I didn't bring three backup outfits to work today." That mix of relief and control is possibletruly.

How to talk to your clinician

It can feel intimidating. Here's a script you can borrow:

"I'm concerned about heavy menstrual bleeding. I'm soaking a pad/tampon every hour for several hours on my worst days, with clots about the size of a quarter. It's lasting around eight days. I feel fatigued and sometimes dizzy. I'd like to check for causes like fibroids, thyroid issues, or a bleeding disorder, and discuss treatments that fit my fertility goals."

Bring your cycle log. Ask about the pros and cons of each option, and what to expect in the first few months. If something doesn't feel right, it's okay to get a second opinion.

When heavy bleeding is urgent

Just to underscore: go to urgent care or the ER if you're soaking through a pad or tampon every hour for more than two hours, feeling faint, or if you're pregnant with heavy bleeding. Trust your instincts. You know your body.

What the evidence says

Medical recommendations evolve, but a few themes are consistent across reputable sources. NSAIDs and tranexamic acid are effective non-hormonal options for many. Hormonal treatmentsespecially the levonorgestrel IUDsubstantially reduce menstrual blood loss. Imaging helps target treatment when uterine conditions are present. And checking iron isn't optionalit's foundational.

If you like to read the source material, clinical summaries from organizations like the CDC and major hospital systems back these approaches. For example, according to the CDC on heavy menstrual bleeding and patient resources from the Mayo Clinic on menorrhagia, a stepwise approachhistory, targeted testing, and personalized treatmentworks best.

You deserve relief

Heavy periods can take over your calendar, your closet, and your mood. But you're not stuck with them. Whether your path is a simple medication tweak, addressing a thyroid issue, switching IUDs, removing a polyp, or choosing a definitive fix, there are real solutions.

If something in this guide sparked a questionask it. If you've tried a therapy that changed your lifeshare it with someone who needs hope. And if your inner voice says, "This can't be normal," listen to it. Getting help isn't overreacting; it's choosing your well-being.

What do you think about the options we covered? Which feel most aligned with your goals right now? If you're unsure, that's okaywe can think it through together. You're not alone in this, and better days really are within reach.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.