Heavy Menstrual Periods

Here we discuss Heavy Regular Menstrual Periods which are not painful. If pain is a significant symptom, see Painful Periods). See also Diagrams — Female Genital System.

Causes of Painful Menstrual Period

โ€ข Uterine Fibroids (aka leiomyomas)
โ€ข Adenomyosis
โ€ข Hypothyroidism
โ€ข Copper IUD (ParaGardยฎ, etc.)  
โ€ข Bleeding Disorders (various diseases; esp. xxxxVon Willebrand Disease, also Leukemia)
โ€ข Previous C-Sections
โ€ข Endometrial Cancer (if >45 y.o.)

Basic Work-Up

  • Pelvic exam for size of uterus (usually can only tell if very enlarged)
  • Blood tests for Anemia (CBC) (blood loss), and Hypothyroidism (TSH)

1.  If either Large Uterus on exam, or severe Anemia on CBC:

  • Ultrasound to diagnose structural abnormalities, e.g. Fibroids or Adenomyosis
  • Since it’s hard to feel a large uterus on exam, Ultrasound is often ordered regardless, especially if:
    • Heavy bleeding is new, or not controlled by medication; or
    • Symptoms: pelvic pressure, hard to urinate, new changes in bowel movements

2.  If fairly elevated blood test for TSH, diagnose Hypothyroidism

3.  If all normal, Reassure Patient

  • If patient has Copper IUD (ParaGardยฎ, etc.), it’s the likely cause of heavy periods
  • If patient has had several C-sections, a C-Section scar may be the cause
  • Aspirin (one dose) can increase any bleeding for a week; NSAIDs can for a day
  • Any new long-acting birth control can cause heavy bleeding at first (IUDs, shots, implants)
  • Women >45 may need tests for Endometrial Cancer, unless periods are very regular

4.  If severe Anemia on CBC, and normal ultrasound, and Normal TSH:

  • Refer to Hematology to rule out Bleeding Disorders

See Heavy Menstrual Periods โ€” Full Text for more in-depth explanations and discussions.

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