Heavy Periods - The more you know!

Samah Ahmed

It's not uncommon for people to struggle with their periods, everything from bloating, to the pain, to the mess! Although it may feel like an inconvenience to have, periods can tell one a lot about their health! Some may notice that their periods have gotten heavier all of a sudden and won't know why. Having a heavy flow on a regular basis (aka menorrhagia) may be an indication of an underlying condition.


What is menorrhagia?

Menorrhagia or Heavy Menstrual Flow is defined by two different scopes. The first, by the NICE Guidelines of the National Institute of Health and Clinical Excellence of the United Kingdom states that Heavy Menstrual Bleeding should be defined as excessive menstrual blood loss which interferes with the woman’s physical, emotional, social and material quality of life, and which can occur alone or in combination with other symptoms” [1]

The second scope is from a research perspective and defined as the loss of more than 80mL of menstrual blood per cycle [2]. It would be unusual for your doctor to ask you how many milliliters of blood you’re losing, and chances are you’re not counting! They may ask questions such as whether you have noticed that your pads regularly require changing every 2 hours. 

What are the symptoms of menorrhagia?

Since the menstruating individual is experiencing blood loss on a regular basis, the symptoms will, for the most part, simulate that of anemia. They may experience fatigue, weakness, headache, exercise intolerance and sometimes, what is known as pica (the craving of unusual foods/substances like crushed ice). [3] Then again, this will differ from person to person, and of course the underlying cause! 

What are the underlying causes of menorrhagia? 

1. Uterine Polyps

In certain cases, polyps may be the culprit behind one’s heavy flows. Uterine polyps are growths that are formed from the inner lining of the uterus (the endometrium). They extend into the cavity and increase the surface area of the endometrium. As a result, when one’s endometrial lining thickens in preparation for the next period, there is more of it formed, therefore, more of it is shed. They are usually identified with the use of a hysteroscopic imaging. A doctor will inspect the uterine cavity using an endoscope that is inserted through the cervix.

2. Adenomyosis

Another possible cause for menorrhagia is Adenomyosis; a condition in which the endometrial tissue (lining the inner aspect of the uterus) grows into the outer layers. As one progresses through their menstrual cycle, the endometrial lining will thicken as it does normally, however, the tissue that has infiltrated the surrounding uterine layers will do the same. Just as with polyps, with more endometrial tissue being present, more will shed, resulting in menorrhagia! 

3. Fibroids

Next on the list if uterine fibroids, also known as leiomyomas. These are noncancerous growths that can occur in the uterus. They are often found in menstruating individuals that are in their childbearing years, and although it may sound frightening, they are not associated with an increased risk of developing uterine cancer! [4]

They can vary in their size; some are undetectable, while others may be palpable in a physical examination and can sometimes be associated with a condition known as endometriosis. 

4. Malignancy

Malignancy and menorrhagia comes in the form of what is known as endometrial hyperplasia; simply put, abnormal thickening of the endometrium. There are many risk factors associated with the malignancy of the endometrium. Some for which include, Increasing age, the use of unopposed estrogen therapy, obesity etc. [5] The common cohort for this condition is a postmenopausal individual with abnormal uterine bleeding.  It can often first be suspected if an ultrasound shows a thick endometrium; through further testing, a diagnosis of endometrial cancer can be made. 

5. Bleeding Disorders

Bleeding disorders are commonly first investigated by a structured history by a physician. Blood tests can be done in order to confirm his diagnosis. Although the presentation of bleeding disorders can very from person to person, it can sometimes present as heavy menstruation! 

6. IUD

Interestingly, certain cases of menorrhagia can be coughed up to Intrauterine Devices! Today, there are a variety of IUDs available for usage, both hormonal and non-hormonal (copper IUD). However, physicians can often warn that IUDs can cause heavy bleeds as a side effect! 

So now you know! 

There are so many causes for heavy bleeds including ones not included in this list. Although periods can be difficult at times, they can be a vital indicator of health related issues. Most of these causes are common for individuals in child bearing years, there can be more outside of this cohort. Although aunt flow can sometimes be a pain, it wants you to know that your health is an important priority! 


  1. https://www.pharllc.com/wp-content/uploads/2014/03/Fraser-Semin-Reprod-Med-2011.pdf 
  1. https://www-uptodate-com.proxy.library.rcsi.ie/contents/abnormal-uterine-bleeding-in-reproductive-age-patients-figo-system-1-terminology-and-symptoms-and-system-2-palm-coein-etiology-classification?search=menorrhagia&topicRef=3263&source=see_link#H2946410662
  1. https://www-uptodate-com.proxy.library.rcsi.ie/contents/causes-and-diagnosis-of-iron-deficiency-and-iron-deficiency-anemia-in-adults?search=Symptoms%20of%20anemia&sectionRank=1&usage_type=default&anchor=H18&source=machineLearning&selectedTitle=2~150&display_rank=2#H18
  1. https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/symptoms-causes/syc-20354288#:~:text=Uterine%20fibroids%20are%20noncancerous%20growths,almost%20never%20develop%20into%20cancer. 
  2. https://www-uptodate-com.proxy.library.rcsi.ie/contents/endometrial-hyperplasia-clinical-features-diagnosis-and-differential-diagnosis?search=menorrhagia&topicRef=14213&source=see_link#H7


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