By: DelCharco M.D. OB/GYN

At a Glance

• Heavy menstrual bleeding affects approximately one in three women at some point in their reproductive years.
  
• Causes range from hormonal imbalance and fibroids to thyroid disorders and bleeding conditions.
  
• Effective treatments include medications, hormonal therapies, minimally invasive procedures, and surgical options when needed.
  
• At DelCharco, M.D. OB/GYN, our team provides comprehensive evaluation and personalized treatment plans to help women regain comfort, confidence, and control over their health.

Quick Summary

Condition: Heavy menstrual bleeding (also known as menorrhagia)
Symptoms: Soaking through pads or tampons every one to two hours, periods lasting more than seven days, passing large clots, anemia
Diagnosis: Pelvic exam, blood work, ultrasound, hormone testing, and sometimes hysteroscopy
Treatment: Hormonal therapy, non-hormonal medications, IUD options, endometrial ablation, fibroid management, and surgical care when appropriate

What Counts as a Heavy Period?

Heavy menstrual bleeding is more than just an “inconvenient” cycle. According to ACOG, bleeding is considered heavy if you experience:

• Soaking through a pad or tampon in less than two hours
  
• Needing to double up on protection
  
• Passing clots larger than a quarter
  
• Periods lasting longer than seven days
  ACOG: Heavy Menstrual Bleeding

Many women normalize these symptoms, but they can signal an underlying medical issue and often lead to iron-deficiency anemia, fatigue, and daily life disruption.

Common Causes of Heavy Periods

Heavy bleeding can be caused by hormonal, structural, or systemic conditions. The most frequent causes include:

1. Hormonal Imbalances

Irregular ovulation or imbalanced estrogen and progesterone can cause the uterine lining to thicken excessively.

• Seen in perimenopause, PCOS, thyroid disease

2. Uterine Fibroids

Fibroids affect up to 70 percent of women by age 50, and many cause prolonged or heavy bleeding.

3. Polyps

Benign growths in the uterus can contribute to spotting or heavy flow

4. Thyroid Disorders

Both hypo- and hyperthyroidism can disrupt menstrual cycles. 

5. Bleeding Disorders

Up to 20 percent of women with heavy menstrual bleeding have an underlying bleeding disorder such as von Willebrand disease.

6. Endometrial Conditions

Such as endometriosis or adenomyosis, which can cause painful, heavy cycles.

7. Other Causes

Pregnancy complications, medications like anticoagulants, or intrauterine device reactions (depending on the type).

How We Diagnose Heavy Menstrual Bleeding

At DelCharco, M.D. OB/GYN, we start with a detailed assessment to identify the root cause. Diagnosis may include:

• Pelvic exam
  
• Ultrasound imaging to evaluate fibroids, polyps, or uterine lining
  
• Hormone testing for thyroid, ovarian, and pituitary imbalances
  
• CBC & iron studies to evaluate anemia
  
• Endometrial biopsy when needed, following ACOG guidelines
  
• Hysteroscopy to directly visualize the uterine cavity

Accurate diagnosis ensures the most effective and least invasive treatment plan.

Treatment Options That Truly Help

Treatment is personalized to your symptoms, your health, and your fertility goals. Options include:

Hormonal Treatments

• Birth control pills
  
• Progesterone therapy
  
• Hormonal IUD, such as Mirena, which reduces heavy bleeding by up to 90 percent
  

Non-Hormonal Options

• Tranexamic acid, FDA-approved to reduce bleeding
  
• NSAIDs to lower blood loss and reduce cramping

Treating Fibroids & Polyps

• Minimally invasive removal
  
• Uterine fibroid embolization (UFE)
  
• Myomectomy for women planning future fertility
  

Endometrial Ablation

A minimally invasive procedure that destroys the uterine lining to reduce or stop bleeding.
Most effective for women who have completed childbearing.

Surgical Options

If other treatments are not effective, or depending on the underlying cause, options may include:

• Laparoscopic procedures
  
• Hysterectomy in severe cases

Your provider will discuss benefits, risks, and what fits your reproductive plans.

Lifestyle and Supportive Care

While medical treatment is the foundation, supportive steps can improve symptoms:

• Iron-rich diet to manage or prevent anemia
  
• Hydration and consistent sleep to regulate hormones
  
• Anti-inflammatory nutrition to reduce cramping
  
• Tracking cycles for pattern changes

When to Seek Medical Care

Consider scheduling an appointment if you experience:

• Bleeding lasting more than seven days
  
• Soaking through pads or tampons every one to two hours
  
• Dizziness or fatigue from blood loss
  
• Severe cramping or pelvic pain
  
• Cycles that suddenly change from your normal pattern
  
• Difficulty completing daily activities during your period

Early evaluation leads to easier and more effective treatment.

Final Thoughts

Heavy periods are common, but they are not something you need to live with or accept as normal. With the right evaluation and personalized care, most women experience significant improvement in their cycles and overall well-being.

At DelCharco, M.D. OB/GYN, we combine advanced diagnostic tools with compassionate, individualized care to help women understand what is happening in their bodies and choose the treatment options that best support their goals. If you are struggling with heavy cycles, we are here to help you find real relief.