Heavy Periods: How to tell if your heavy periods are “normal”

Menstruation varies from person to person, making it harder to distinguish normal from excessive blood loss. So how do you tell what is “normal?”

Let’s get medical: In clinical research studies, the symptom of heavy menstrual bleeding (HMB) is defined as blood loss larger than 80 mL per cycle.

However, blood loss can be very hard to measure, unless you use a menstrual cup. And even if you lose less than 80 mL, it can still affect your quality of life, particularly if the timing of your periods is irregular and, therefore, difficult to anticipate. Consequently, the more accepted and practical definition of HMB is “excessive menstrual blood loss which interferes with a woman’s physical, social, emotional and/or material quality of life.”(National Institute for Health and Care Excellence or NICE)

Causes of Heavy Menstrual Bleeding

There are a variety of conditions that can cause HMB. The most common conditions include:

  • Polyps, or growths in the uterine lining, usually cause spotting or bleeding between periods and sometimes HMB.
  • Adenomyosis, the abnormal growth of uterine lining (endometrium) into the muscular wall of uterus, but can sometimes cause heavy and/or painful periods.
  • Uterine fibroids, benign growths (smooth muscle tumors) on the uterus, also known as leiomyomas, can sometimes cause HMB. If they grow in the uterine lining (endometrium) they will most likely cause HMB.
  • Cancers and precancers are very uncommon, but important, causes of abnormal bleeding, particularly for individuals under the age of 40. While they can cause HMB, cancers and precancers more likely cause irregular bleeding or bleeding between periods.
  • Coagulopathy, an inherited disorder preventing the blood from clotting normally, will cause HMB usually from menarche (the first period).
  • Ovulatory disorder, the absence or irregularity of ovulation, is a hormonal problem that may cause irregular bleeding that may or may not include HMB as a symptom.
  • Endometrial disorder, an abnormality in the lining of the uterus, prevents the tissues from stopping the bleeding normally.

Most medications and birth control pills don’t cause HMB, but there are two exceptions: Copper-containing intrauterine devices may increase the amount of blood lost during menstruation and anticoagulants (“blood thinners”), which prevent blood clots, usually cause HMB.

Do you have Heavy Menstrual Bleeding?

Understanding whether or not you suffer from HMB requires the accurate recording of your menstrual history. The intensity of bleeding varies from person to person, so determining what is clinically heavy is tricky. Furthermore, while a single period can be heavy, a real problem isn’t likely to exist unless the HMB is present at least most of the time. The medical definition of this is when HMB is present for the majority of periods within the previous six months.

Your healthcare provider may ask you how many (and what size) pads/tampons you have been using in one day. Also, blood clots are very important to note — their size, number and color. They contain blood, and it is important to measure and count them to get an approximation of how much blood has been lost.

  1. Distinguish between regular and maxi tampons or pads, as maxi can usually absorb twice more than regular (each maxi tampon or pad should be counted as two regulars).
  2. Check how soaked your tampon or pad is. Is it fully soaked with blood, or just half? (For half soaked, divide the number of half soaked pads by two.)
  3. Count blood clots; they contain blood too.
  4. For a menstrual cup, check the volume capacity and measure how full the cup is (e.g. if it is a 10 mL cup and it is ¾ full, the amount of the blood your menstrual cup contains is 7.5mL).
  5. If the number of soaked tampons or pads is sixteen or more for the entire duration of your period (or eight fully soaked maxi tampons or pads), then your flow is heavy.
  6. If you note 80mL or more blood with your menstrual cup for one entire cycle, your flow is heavy.

Here are some more guidelines to determine if what you are experiencing is heavy:

  1. Your menstrual period lasts longer than seven days.
  2. Your flow soaks through tampons or pads every hour for a few hours in a row.
  3. You need to change pads or tampons during the night.
  4. You have multiple grape-sized (or larger) blood clots.
  5. Your heavy menstrual flow keeps you from doing things you would normally do.
  6. You are tired, have a lack of energy or are short of breath.
  7. You feel heavy pain in your abdomen and lower back. Credit- CLUE
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