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 Heavy Non-Painful Menstrual Periods
| โข Uterine Fibroids (aka leiomyomas) โข Adenomyosis โข Hypothyroidism โข Copper IUD (ParaGardยฎ, etc.) | โข Bleeding Disorders (various diseases; esp. xxxxVon Willebrand Disease, also Leukemia) โข Previous C-Sections โข 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 (ibuprofen, etc.) 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.