Why is my period so heavy?
Crime scene level periods are not fun. Learn the most common root causes of heavy periods, and what tests to help you figure out why your (menstrual) cup is overflowing.
October 16, 2024
We're talking crime-scene-level-periods. The kind of periods that soak your sheets, make you google "how much blood loss is too much blood loss" and make you change your tampon every 30-90 minutes.
A (far too) heavy menstrual flow.
What is considered a “heavy” period?
The medical term for heavy periods is menorrhagia, a word that I can never spell correctly without looking up.
We define this by periods that:
🩸 last more than a week
🩸require changing out of pads or tampons every hour for multiple hours
🩸not being able to make it through the night without getting up to change your pad/tampon
🩸 passing clots the size of a quarter or bigger
🩸 or generally not being able to function normally when on your period. Think not wanting to leave the house, exhaustion and dizziness that inhibits daily function.
An important note - even if this has been your normal for your entire menstrual life, this level of flow is still abnormal, even if quite common.
Aside from the "inconvenience" factor of not being able to leave your house for days without leak anxiety, ruining too many pairs of underwear/ pants / sheets, and paying way too much for your monthly fix of sanitary supplies - a heavy flow like this is a huge issue in terms of your health. It's near impossible to have adequate iron levels, leaving you literally drained of your energy and vitality.
It's also indicative that something is off balance that needs exploration.
Your period is a vital sign, and heavy and painful periods are a message that something is off.
Let’s explore the most common reasons for heavy periods I see in my patients.
Hypothyroidism.
Your thyroid controls more than just your metabolic rate. If thyroid hormones aren't in optimal ranges, heavy periods are a common symptom. You might also experience fatigue, hair loss, low body temperature and constipation. A full thyroid panel — not just TSH — will help evaluate if you need further intervention.
Postpartum.
It's pretty common for the first few periods to be particularly heavy after giving birth. If they remain much heavier than your normal after 6 months, some testing is warranted.
You have a copper IUD.
An extremely common side effect of the copper IUD (Paragard) is heavier and more painful periods. This is due to the copper causing localized inflammation to the uterus, which increases prostaglandin levels (hormone like substances that cause uterine contractions which stimulate the release of the lining... and also make you poop more when you're on your period 💩).
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Chronic inflammation.
In a similar mechanism to the copper IUD, women with elevated CRP levels (a marker of systemic inflammation) are more likely to have heavy and more painful periods.
Fibroids, polyps, endometriosis
Sometimes heavy periods are the only symptom of growths in the uterus like polyps or fibroids. You'll need imaging to know if they are present, so ask your doc to order a pelvic ultrasound if you suspect this. We also want to rule out endometriosis, which can cause heavier flow in addition to extremely painful periods.
Estrogen and progesterone balance.
While "estrogen dominance" is not a medically accepted term, we do see that those with higher levels of estrogen relative to progesterone are more likely to have heavier periods. This is due to excessive stimulation of the uterine lining.
Perimenopause.
Add heavy periods to the list of (more than) annoying peri symptoms. During perimenopause, progesterone slowly declines while estrogen can take dramatic upswings causing these two hormones to be off balance. This imbalance causes the uterine lining to grow too thick, and increases prostaglandins needed to stimulate the uterus to release the lining. So you'll have heavy, longer, and more painful periods.
Perimenopause can also lead to periods showing up more often... and when you are having bloody-massacre level periods every 21 days then that's a big ass problem for your quality of life as well as your iron stores.
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How do we find out what's causing your heavy flow?
We test. And use lab data in combination with symptom data to understand the next steps. Just like with most things, we need to get to the root of why you're having heavy and painful periods before knowing how to treat it.
Heavy periods are absolutely messy, inconvenient, painful, and can cause downstream issues like severe iron deficiency and all of the symptoms that go along with that. But they do not need to be your normal.
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