Heavy menstrual bleeding

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Heavy menstrual bleeding (HMB)

What is it?
HMB is when a woman’s period is much heavier than normal. It used to be called menorrhagia. A period is considered heavy if it lasts more than 7 days or you lose more than 80 mL of blood in the cycle. Other signs include soaking a pad or tampon every 2 hours or needing to change it in the middle of the night.

What is normal?
Most people have a cycle every 21–35 days, with about 5 days of bleeding and a total blood loss of 25–80 mL. If your cycles are outside this range, it’s considered abnormal and you should talk to a healthcare professional.

Causes
Sometimes no specific problem is found. Possible causes include:
- Structural issues in the uterus (like fibroids, polyps, or adenomyosis)
- Not ovulating (anovulation)
- Bleeding disorders or hormonal problems
- Thyroid issues or, rarely, cancer of the reproductive tract

How it’s diagnosed
Doctors take your history and do a physical exam, sometimes with ultrasound. Blood tests or a procedure called hysteroscopy may be used if needed. In many cases, treatment can start based on symptoms and exam alone.

Treatment
The approach depends on the cause and how much it affects daily life. Options include:
- Levonorgestrel-releasing intrauterine system (LNG-IUS): a small hormone-releasing device put in the uterus; often effective and can improve quality of life.
- Hormonal pills: combined birth control pills or progestin-only pills for several months.
- Tranexamic acid: a medicine that helps reduce bleeding.
- NSAIDs (like ibuprofen): can lessen bleeding and relieve pain.
- Other hormonal options: injections or newer hormone-releasing intrauterine systems.
- Surgery (if medications don’t help or if fibroids are present and treatment goals include stopping periods): endometrial ablation (destroying the lining) or hysterectomy (removal of the uterus). Myomectomy (removing fibroids) is an option when fibroids cause bleeding and fertility is to be preserved.

Impact on life
HMB can affect energy, mood, work, and social activities. If heavy bleeding leads to anemia, iron supplements may be needed to restore levels.

When to seek help
If you have very heavy periods, cycles that are often irregular, bleeding between periods, or you’re tired, faint, or short of breath, see a healthcare provider. Many people can be helped with less invasive treatments, and surgery is only considered after other options.