Heavy or long periods may not immediately sound alarm bells in your head, especially if many of your friends and family members also share the same experience. But if your period lasts longer than a week, or you’re going through menstrual products at a rapid rate, it’s natural to wonder whether something is off.  

That’s why we spoke with Nkeiruka Mbah, M.D., an OB/GYN and physician on the medical staff at Texas Health HEB and at Texas Health Women’s Care in Bedford, to discuss when you should be concerned about heavy or long periods.

What Is a Heavy or Long Period?

The average menstrual cycle typically lasts between 21 to 35 days, with periods lasting about two to seven days. A heavy period involves excessive bleeding and an extended duration.

“A heavy period is defined as more than 80ml of blood loss per menstrual period,” Mbah says. “However, it might be difficult to quantify this. Therefore, a good rule of thumb is if you’re passing a large number of clots or changing a pad/tampon every 1-2 hours for several hours in a row, this will also constitute heavy bleeding.”

Mbah adds that a period that lasts more than 8 days is considered prolonged.

Normal Variations vs. Potential Concerns

While a heavy or long period is, at best, inconvenient, and, at worst, something to be concerned about, Mbah notes there are circumstances in which it’s normal for your cycle length and flow to change.

During adolescence (ages 10-19) and perimenopause (ages 40-45), irregular periods or changes in flow are common due to hormonal fluctuations. This is why using certain hormonal contraceptives or receiving hormone therapy may also cause irregular bleeding or heavier periods at first.

However, there are circumstances in which an irregular period can signal some issues. Some common issues that may cause heavy or long periods include:

• Uterine Fibroids: Noncancerous growths in the uterus that can lead to heavy bleeding and pain.
• Endometriosis: A condition where tissue similar to the lining of the uterus grows outside the uterus, causing heavy bleeding and severe pain.
• Adenomyosis: When the tissue lining the uterus grows into the muscular wall, resulting in heavier or prolonged menstrual bleeding.
• Polycystic Ovary Syndrome (PCOS): Imbalances in reproductive hormones that may lead to irregular periods and heavy bleeding.
• Uterine Polyps: Noncancerous growths attached to the inner wall of the uterus and are made up of tissue, typically endometrial tissue or glandular cells. They vary in size and can range from a few millimeters to several centimeters in diameter.
• Bleeding Disorders: Conditions like von Willebrand disease or platelet function disorders can cause excessive bleeding during menstruation.
• Non-Hormonal Medications: Medications such as anticoagulants (blood thinners), nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, and steroids can all cause changes in the flow and length of your menstrual cycle.
• Cancer: Cancer affecting the reproductive organs, such as the uterus, cervix, or ovaries, can manifest with abnormal menstrual bleeding patterns as one of the symptoms. Additionally, cancers outside the reproductive system, such as blood cancers like leukemia or cancers affecting clotting factors, can sometimes lead to heavy or prolonged menstrual bleeding due to their impact on blood clotting mechanisms or hormonal balances in the body.

Signs You Should Seek Medical Attention

While Mbah notes that occasional changes in menstrual flow may not require you to make a special appointment to chat with your doctor, there are some instances that signal it’s time to seek medical advice.

• Excessive Clotting: Passing large blood clots (larger than a quarter) frequently during your period.
• Pain or Discomfort: Severe cramps, pelvic pain, or discomfort that interferes with daily activities.
• Symptoms of Anemia: Feeling fatigued, weak, heart palpitations, or experiencing shortness of breath, which could be signs of anemia due to excessive bleeding.
• Sudden Changes: Abrupt changes in menstrual flow or pattern, especially if you’ve previously had regular periods.
• Bleeding Between Periods: Unusual bleeding between periods or after intercourse.
• Menstrual Irregularity Post-Menopause: Any bleeding or spotting after menopause should be promptly evaluated.
• Headaches: While headaches alone might not always indicate a severe issue when they occur alongside irregular periods or other concerning symptoms, it’s essential to have a healthcare professional evaluate the situation.

Steps to Take

If you’re experiencing prolonged or heavy periods and exhibit any concerning symptoms, Mbah says it’s crucial to reach out to a gynecologist or your health care provider for an evaluation.

If you can, try to maintain a record of your menstrual flow, noting the duration, flow intensity, and any accompanying symptoms. This can help provide some good insight to your doctor and inform them on what tests to potentially order.

“Always include all medical history and family history of heavy menstrual bleeding,” Mbah adds.

Your health care provider may suggest blood tests, ultrasounds, or other imaging studies to identify the underlying cause.

“In most cases, the causes of heavy menstrual bleeding can be diagnosed with your menstrual history and a list of medications you’re currently taking, then some tests such as a pelvic exam, cervical pap or biopsy, endometrial biopsy or other sampling, a sonogram and blood work to evaluate hemoglobin and platelets.”

You may not need every test listed, but these are common tests that may be ordered.

Treatment Options

After the results of any testing are evaluated, you and your doctor can discuss treatment options. Treatment for heavy or prolonged periods largely depends on the underlying cause.

“Options typically hover around nonsurgical and surgical management,” Mbah says. “Nonsurgical management includes hormone therapy or hormonal contraceptives, medications to treat or prevent excessive blood loss, such as tranexamic acid, or medications that affect the body's production of certain hormones, such as gonadotropin-releasing hormone agonists or antagonists.”

Surgical management includes but is not limited to endometrial ablation, myomectomy (fibroid removal), or dilation and curettage (D&C) if the irregular bleeding is due to a miscarriage.

In severe cases, or when other treatments aren’t effective, a hysterectomy, or the surgical removal of your uterus, might be recommended. In some cases, it may also involve the removal of the cervix, ovaries, and fallopian tubes.

While Mbah adds that there aren’t any “true” home remedies that can help with heavy menstrual bleeding, maintaining a healthy balanced diet that includes iron-rich foods, managing stress, and maintaining a healthy lifestyle can always help complement any medical treatments.

The Takeaway

If you’re experiencing heavy or prolonged periods, or any sudden or significant changes in your menstrual cycle it’s essential to consult with your OB/GYN or doctor. Seeking prompt medical attention allows for proper evaluation, diagnosis, and timely management of any underlying conditions causing the irregular bleeding.

Additionally, staying on top of routine check-ups and open communication with your health care providers are crucial to address and manage any menstrual irregularities effectively.

Staying on top of your health is not only important to you, it’s also important to us. If you are looking for a doctor, Texas Health Resources offers an easy-to-use tool. Simply choose the specialty, type in your zip code and select a range. Once a list of physicians appears, you can click on a physician and access contact information, education background and a list of insurance plans the doctor accepts.