Menorrhagia is to periods what a waterfall is to a trickle. If you have menorrhagia, your period is less of a typical flow and more of a relentless gush that feels impossible to keep up with. This condition, which affects around one in five people in the United States, is bleeding on a whole other level.
If your period is abnormally heavy, lasts for longer than seven days, or both, you probably have menorrhagia.
In 2007, a group of experts published a paper in the journal Fertility and Sterility in an attempt to create a consistent definition for abnormal bleeding. The paper defines losing more than 80 milliliters of blood (the equivalent of about 1/4 of a 12-ounce can of soda) as abnormal blood loss. But what does that translate to in real life? “We do not attempt to actually measure blood loss milliliter by milliliter,” Christine Sterling, M.D., ob/gyn and women’s health expert, tells SELF. “Instead, we rely on the patient’s description of her bleeding.”
Maybe your periods have always spanned longer than a week, or you’re used to expelling blood clots as big as a quarter or larger. Perhaps you’ve come to see it as normal that you bleed through one or more pads or tampons many hours in a row, or that you have to change them in the middle of the night unless you want to ruin your mattress. Even if you’ve experienced these symptoms all your life, they’re not normal. They’re classic signs of menorrhagia, and you don’t have to live with them.
Menorrhagia isn’t just an annoyance—it can interfere massively with everyday life. People with menorrhagia often can’t take part in their usual activities during their period because there’s so much blood loss and cramping, says the CDC. You might even feel tired, low on energy, or get out of breath because you’ve lost so much blood. If any of these symptoms sounds familiar to you, you need to see a doctor for evaluation.
Once you see your doctor, they can ask questions and run tests to figure out the cause of your menorrhagia.
They’ll want to know what other symptoms you’re experiencing, so don’t hold back. Giving your doctor details can help them narrow down the list of potential causes and decide on the best course of testing.
In an attempt to figure out your bleeding, your doctor may administer a pregnancy test, board-certified reproductive endocrinologist Mark P. Trolice, M.D. tells SELF. Abnormally heavy bleeding can be a sign of a miscarriage or ectopic pregnancy (a potentially life-threatening pregnancy outside the uterus, usually located in the fallopian tube). Even if you think you're not pregnant, it's good to rule it out.
They might also do blood work to check for anemia, Dr. Sterling says. Anemia happens when you don’t have enough healthy red blood cells in your body. It can occur due to heavy menstrual bleeding that causes you to lose too much blood, and it’s the cause of those seemingly random symptoms like low energy and fatigue. “You do not have to have anemia to have menorrhagia, but it does speak to the severity of the condition,” Dr. Sterling says.
Blood work can also help doctors see whether you might have a thyroid condition like hypothyroidism (when your thyroid doesn’t release enough hormones). Since your thyroid influences so many systems in your body, having hypothyroidism can make your period a beast. It can also lead to symptoms like fatigue, constipation, weight gain, and memory troubles.
A blood test could hint at another hormone-related potential menorrhagia cause: polycystic ovary syndrome (PCOS). PCOS can cause hormonal imbalances that result in your uterine lining growing without shedding for months, meaning that if your period finally does arrive, it might go way overboard. Though wonky periods are a classic symptom of PCOS, its characteristic hormone imbalance might also bring about excessive facial and body hair, along with tough-to-treat acne.
Evidence of a bleeding condition like idiopathic thrombocytopenic purpura (ITP) could also appear on a blood test, since it’s marked by a low platelet count. (That's what makes it hard for your blood to clot properly, resulting in bleeding too much.) You’d typically have other signs of ITP, though, like a rash of small pinprick-like dots on your legs and bruising way too easily.
Testing doesn't have to stop at blood work. With a pelvic exam, your doctor can check for issues like cervical polyps, which are finger-like growths that hang from the cervix and bleed, according to the U.S. National Library of Medicine. Or they could decide to do an ultrasound to check for uterine fibroids (non-cancerous growths in and on the muscle of the uterus—these may also be detectable in a pelvic exam) and uterine polyps (growths in the uterine lining that can protrude into the uterus and bleed).
In addition, your doctor may decide a Pap or biopsy is in order. A Pap can help them see if you’re dealing with an infection, inflammation, or cell changes. In some cases, cell changes can indicate cancer (keep in mind that this is nowhere near the most common reason why you’d experience heavy menstrual bleeding). An endometrial biopsy can also help detect whether your excessive bleeding is due to cancer cells.
The treatment plan for menorrhagia depends on the underlying cause, but the bottom line is that help is out there.
Given how many possible causes there are—and how different everyone’s body is—there’s a plethora of potential menorrhagia treatments. They can range from hormonal methods, like a birth control pill or IUD that contains progestin to thin your uterine lining, to excising growths like cervical or uterine polyps so they can no longer cause OTT bleeding.
“There are many treatments for heavy periods, and sometimes you have to try more than one before you find the right solution,” Dr. Sterling says. “At the end of the day, what is most important to me is the patient’s experience. I want to get to the bottom of it and find a treatment option that works.”