How heavy is too heavy? Doctor explains when menstrual bleeding needs medical attention, what qualifies as heavy periods

Menorrhagia, or heavy menstrual bleeding, can result in severe health impacts. Dr Pranathi highlights the importance of seeking medical advice and treatment.

Periods can be painful, and several medicines are available on the market that can be helpful. However, in India, painful periods are often dismissed as normal, which isn't a surprise considering the taboo attached with it. As a result, for many years, women tend to normalise their pain without consulting a doctor.

In an effort to understand what qualifies as heavy menstrual bleeding and when it is a cause for concern, HT Lifestyle got into an interaction with Dr Pranathi Aravind, senior consultant, department of obstetrics and gynaecology, Gleneagles BGS Hospital, Bengaluru. She also discussed warning signs to look out for, common underlying causes, and health risks of untreated heavy menstrual bleeding.

What qualifies as heavy menstrual bleeding, and when is it a cause for concern?

According to Dr Pranathi, heavy menstrual bleeding is also called menorrhagia. This refers to blood loss that is significantly greater than normal, or bleeding that lasts significantly longer than expected.

She also shared some signs of too heavy periods, including:

• If the woman soaks through a sanitary pad or tampon once every two hours
• If she needs to use two forms of protection together, like a pad and a period cup
• If she wakes up in the night to change her sanitary products
• If she passes large blood clots or if her periods last longer than seven days.

In India, painful periods are often dismissed as normal, but they shouldn't be. (Pexel)

“Another huge indicator would be the bleeding getting so heavy that it interferes with work, school, social activities or sleep. Heavy periods are often ignored and considered normal, but they shouldn’t be. Especially if it causes dizziness and fatigue,” she added.

Common underlying causes that shouldn't be ignored

As per Dr Pranathi, heavy menstrual bleeding is a symptom of something bigger, indicating that some underlying causes might exist. She explained,

• One of the most common causes is uterine fibroids. Fibroids are non-cancerous tumours in the uterus.
• Adenomyosis, where the uterus lining grows into the muscle of the uterus, can also lead to painful and heavy periods.
• Hormonal imbalances in the body, particularly those involving estrogen and progesterone, can also cause irregular thickening of the uterine lining and heavier bleeding.

Other causes can be polyps in the uterus, a non-cancerous growth in the inner lining of the uterus (though it can occasionally contain precancerous or cancerous cells), thyroid disease, Polyendocrine Metabolic Ovarian Syndrome (PMOS), certain drugs like anticoagulants (medications that help reduce blood clotting), and complications during pregnancy, as per Dr Pranathi.

Women over the age of 40 must also not ignore heavy bleeding, as it may be a precancerous condition or even uterine cancer, she cautioned. “But there are a variety of causes for heavy menstrual bleeding. One must not self-diagnose or assume that heavy periods are simply due to age or stress,” she added.

One of the most common causes is uterine fibroids. (Pexel)

Warning signs that indicate it's time to seek medical attention

One must seek medical intervention if they consistently experience heavy menstrual flow, especially if they are soaking through their pads every hour for several hours, passing large clots, or even bleeding for more than one week (7 days).

If the bleeding suddenly increases and becomes heavier than usual, there is bleeding happening in between cycles, after menopause or even if the heavy bleeding is accompanied by intense stomach pain, fever or abnormal odour, medical attention is necessary.

Symptoms like extreme tiredness, breathlessness, dizziness, palpitations and fainting can also suggest significant blood loss during the period and anaemia, which must not be ignored. If the bleeding is severe enough to cause weakness or signs of shock, immediate medical attention is required as well.

What are the health risks of untreated heavy menstrual bleeding?

Anaemia is one of the most common complications of prolonged heavy menstrual bleeding, Dr Pranathi stated. “Continuous blood loss reduces the body’s iron stores, making it difficult to produce enough healthy red blood cells,” she added.

Moreover, women suffering from anaemia often complain about persistent fatigue, headaches, weakness, the inability to concentrate for long durations, shortness of breath during regular activities and overall productivity gets hampered as well. If this is left untreated, severe anaemia can lead to heart malfunction and other health troubles.

Anaemia is one of the most common complications of prolonged heavy menstrual bleeding. (Picture credit: Freepik)

Beyond the physiological effects, heavy menstrual bleeding can also have a significant mental and social impact. Many women limit travel, avoid exercise, and miss work/school as a reason, and even experience immense anxiety about experiencing unexpected and severe bleeding.

What diagnostic and treatment options are available?

Dr Pranathi stressed that treatment for severe menstrual bleeding begins with a detailed menstrual history, medical history, and physical examination. She stated that blood tests are also performed to check haemoglobin levels, iron stores, thyroid function, hormone levels, and the risk of clotting disorders.

“A pelvic ultrasound is often the first imaging test performed to identify fibroids, adenomyosis, ovarian cysts or other structural abnormalities. Depending on the woman’s age, symptoms and risk factors, additional tests like a hysteroscopy or an endometrial biopsy may be recommended to examine the uterine lining more closely,” Dr Pranathi suggested.

Depending on the cause and severity of the condition, the woman's age, and whether she wishes to bear children in the future, an individual treatment plan is created. “Many women often opt for different medicines like hormonal contraceptive pills, progesterone therapy or a levonorgestrel-releasing intrauterine device (LNG-IUD) to reduce excessive menstrual bleeding. Iron supplements are prescribed to those with anaemia as well,” she added.

In cases where the medication fails or if there is a structural problem like large fibroids or very severe adenomyosis, minimally invasive procedures or surgery may be considered, she explained. The surgeries may include polypectomy, myomectomy, and a hysterectomy in rare cases.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.