Do you ever ask yourself, “Why is my period so heavy?” In this article, I will explain what a heavy period is. I will also show you how to measure your blood loss. Lastly, I will discuss 18 reasons for heavy periods.
Menorrhagia: Heavy menstrual bleeding. Excessive bleeding, either in a number of days or in the amount of blood, or both.
Blood loss during a normal menstrual period ranges from 20 to 60 ml, with an average expected blood loss of around 30 to 40 ml. Excessive blood loss of 80 or more mL is considered excessive and increases one’s risk for iron deficiency anemia [1,2]. It’s challenging to determine the exact amount of blood one loses during a menstrual cycle in milliliters. Many women who report heavy bleeding during menses are, in fact, within the normal range, or even in the light range. Conversely, in one study, 40% of women with blood loss of greater than 80 ml (excessive uterine bleeding) thought their periods were normal or even light! [2,3,4]
Using a menstrual cup may be the easiest way to tell how much blood you are actually losing. A menstrual cup, such as the Moon Cup, Luna Cup, Diva Cup, or The Keeper, holds up to one ounce (30 mL). Most women likely change their cup before it reaches the 30 ml mark, so recording the amount of blood in the cup every time you change it would be required to get an accurate measurement. Some cups have a line indicating 7.5 ml and 15 ml.
A normal size tampon holds about one teaspoon (5 ml), so soaking 16 or more tampons during a menstrual cycle would be considered excessive bleeding. The average 30-40 ml blood loss would soak between six and eight regular tampons. A “super” tampon can hold 10 ml of blood, therefore, eight or more soaked “super” tampons would be considered excessive. BTW, I don’t think there is anything super about a tampon. It has been my experience that tampons increased my cramping. I’ve been using unbleached cloth pads for four years now and love them.
Blood collected in a pad is a bit more challenging to calculate. Depending on the brand, a pad can hold between 5 and 15 ml, but most women don’t wait until the pad is thoroughly soaked before changing it.
Another indication that you may be experiencing excessive blood loss is feeling faint or dizzy when standing up. As I mentioned above, excessive blood loss can lead to iron deficiency anemia; therefore, it is recommended to have your blood hemoglobin and serum ferritin levels checked before taking iron supplements. Too much iron can be toxic.
NORMAL RANGES VS. OPTIMAL RANGES: “If you take a look at your blood work, you will see your result, and then you should see a range next to it. These ranges tend to vary from lab to lab, so they can be quite confusing. You want to focus on the optimal range. This is a narrower range that you should aim for in order to achieve better hormonal and overall health.”- Nicole Jardim, Women’s Hormonal Health Coach.
For example, my lab indicates that the normal range for ferritin levels is between 15 and 150 ng/ml. The optimal range is much narrower and is 70-90 ng/ml (especially if there is hair loss). And HemoglobinA1C: Most ranges say it should be less than 6% but optimally you should aim for less than 5.4%.
Possible causes of heavy menstrual bleeding may be, but are not limited to:
- miscarriage
- thick endometrial lining (excess estrogen buildup). The thickness of your endometrial lining can be confirmed via ultrasound.
- Uterine fibroids can prevent the uterus from contracting effectively and lead to excess bleeding. Submucosal fibroids, which make up about 10% of fibroids, are the type that is usually associated with heavy bleeding.
- low progesterone or no progesterone from anovulatory cycles. If you aren’t ovulating, your corpus lutem is not forming and therefore not producing progesterone.
- endometrial polyps (small growths)
- IUDs
- vitamin A deficiency
- malignancy
- infection. Although it’s rarely the cause.
- adenomyosis
- bleeding disorders
- low thyroid function
- immature endocrine system
- perimenopause-ovaries may be less sensitive at this stage, so the hypothalamus doesn’t get the signal to send out LH, therefore ovulation doesn’t happen, but the uterine lining keeps building up until it eventually sheds. This is a time when estrogen is higher than normal and progesterone is lower than normal. Check out this article from the Center for Menstrual Health and Ovulation Research for information on how your doctor may be able to help you reduce your heavy bleeding.
- Hyperglycemia (high blood sugar) interferes with hypoxia-inducible factor (HIF). The more of this you have, the faster you heal and cut off the bleeding.
- If you have dysfunctional uterine bleeding (DUB), it would be helpful to know if you are ovulating or not. The causes of ovulatory and anovulatory DUB are different, so knowing your body can give you clues to what is going on.
- Anemia! Yes, heavy bleeding can cause anemia, but anemia can also lead to heavy bleeding. As Dr. Jennifer Karon-Flores explained, “Basically, iron helps with platelet aggregation, so in absence of enough iron, platelets decrease and don’t work as well. Also, the arterioles in the endometrium get poor signaling in this environment, which further enhances the bleeding.” Here is a study that explains the mechanisms at play.
- Item of Interest: NIH funds studies to assess potential effects of COVID-19 vaccination on menstruation
As you can imagine, knowing the cause of heavy menstrual bleeding is crucial to addressing the problem at its root. Knowledge is power; it pays to know your body! When you understand your body, you become an active participant in the healing process. If you suspect you may have a serious medical condition, please consult your physician.
Sources
1. Harlow S: Menstruation and Menstrual disorders, IN: Goldman M, Hatch M, eds.: Women and Health, San Diego, Academic Press, 2000
2. Botanical Medicine for Women, Dr. Aviva Romm
3. Baker S: Menstruation and Related Problems and Concerns, In: Youngkin E, Davis M, eds: Women’s Health: A Primary Care Clinical Guide, Stamford, CT, Appleton & Lange, pp. 140-160 1998
4. Hallberg L: Menstrual blood loss: a population study, Acta Scand Obstet Gynecol 45:321-351, 1966
5. Vitamin A in the treatment of menorrhagia
6. Triad of Iron Deficiency Anemia, Severe Thrombocytopenia, and Menorrhagia—A Case Report and Literature Review
Author: Barbara Horsley has more than 26 years of experience as a licensed massage therapist. She specializes in abdominal massage and Visceral Manipulation™ and is an NCBTMB-approved educator. In addition to being certified in abdominal massage, she also studied biomechanics and restorative exercise. She is also a Certified Women’s Herbal Educator and a graduate of the IWHI Perimenopause & Menopause Certificate Program.