Should I Worry About a Heavy Period?

Heavy periods are common among women; in fact, one out of every five women have them. But how do you know what’s heavy, what’s normal and when to talk to your doctor about it?

We spoke with gynecologic oncologist Pamela Paley, MD from the Overlake Cancer Center to learn more about symptoms, causes and treatments of abnormal uterine bleeding.

What causes abnormal bleeding?

While periods vary from woman to woman, a normal period lasts up to seven days. Abnormal uterine bleeding (AUB) is a menstrual period that lasts longer than seven days and is heavier than normal (soaks through one or more pad or tampon every hour for several hours in a row). It can be caused by many different structural and hormonal abnormalities. In women who are not pregnant and haven’t yet reached menopause, most AUB is caused by benign, noncancerous conditions. The most common causes are fibroids, polyps in the lining of the uterus, adenomyosis (where tissue grows into the wall of the uterus), irregular ovulation and blood clotting disorders. In rare cases it’s caused by precancers or cancers of the cervix or uterus.

In general, heavy bleeding typically originates from the uterus, while spotting or light bleeding may be from any genital tract site.

If the bleeding occurs after sex, it may be due to contact during intercourse of any site along the lower genital tract that easily tears (e.g., due to inflammation of the cervix or if the tissue of the vulva or vagina has thinned due to low estrogen) or has a cervical polyp or vulvar ulcer. If the bleeding occurs consistently after intercourse, this may indicate cervical precancers and cancers. It’s important to see your healthcare provider for evaluation.

What should I expect at my doctor appointment?

Your healthcare provider will ask you about your health history, menstrual cycle and will perform a pelvic exam that should include evaluation of all lower genital tract sites to assess for lesions or areas that tear more easily. If any lesions are noted, biopsies should be obtained. You may also have a pelvic ultrasound.

What treatments are available for AUB?

The results of your exam will determine what treatment you receive. Typical treatments may include birth control to help balance hormones, anti-inflammatory pain medication to reduce pain and blood loss, or surgery to remove polyps or fibroids.

Is it normal to bleed after menopause?

Menopause is defined as the absence of periods for a year. Any woman with bleeding after menopause should be seen by her healthcare provider. It can be caused by benign, precancerous or cancerous conditions and requires evaluation to rule out the possibility of cancer including endometrial, cervical, vaginal and vulvar cancer. A pelvic exam, biopsy of any suspicious lesions, endometrial biopsy (biopsy of the lining of the uterus) and, in some cases, a pelvic ultrasound should be performed.

If you’re experiencing heavy periods, have abnormal bleeding post-menopause or have concerns about your health, see your healthcare provider.