Causes of a Heavy Period

Heavy menstrual bleeding is a symptom associated with various gynecological disorders, systemic diseases and with the use of certain medication. The presence of other signs and symptoms such as severe menstrual pain, cramping, abnormally large blood clots and any abnormal vaginal discharge should be noted to aid with a diagnosis.

The most common cause of a heavy menstrual bleed is related to hormonal fluctuations. These changes may arise for any number of reasons, either due to underlying gynecological conditions, medication, changes in the body’s physiology or with extreme stress to the system as may be seen after a severe illness. Some of these causes can be transient and may not occur again.

Miscarriage may cause heavy menstrual bleeding. Sometimes a heavy period is experienced by a woman who is not even aware that she is pregnant and is the only symptoms of pregnancy and the subsequent loss of pregnancy. It is the body’s way of expelling the products of conception. Women who are aware of their pregnancy need to be cautious about any bleeding during the first trimester, irrespective of the quantity of blood, as it may be a sign of a threatened abortion or ectopic pregnancy.

Polycystic ovarian syndrome and the start of premature ovarian failure or menopause (perimenopause) may be marked with anovulatory periods. This means that an egg cells is not released from the ovary (anovulation) and can disturb the normal hormonal changes in the menstrual cycle. A heavy period or prolonged period can be a symptom of this disturbance.

Growths in and around the uterus may also cause heavy periods. Uterine fibroids and uterine polyps are benign growths of the uterus. Endometriosis is when the endometrial tissue (inner lining of the uterus) occurs at sites outside of the uterus but usually within the pelvis. The different cancers of the female reproductive tract like ovarian cancer, uterine cancer or cervical cancer very rarely cause excessive vaginal bleeding.

Bleeding disorders are conditions where the normal blood clotting process is affected like in hemophilia or von Willebrand’s disease. This can cause heavy and prolonged menstrual periods.

Medication such as drugs used to alter the hormone levels and anticoagulants specifically may lead to abnormalities of menstrual bleeding. Other medication such as anti-inflammatory drugs may also have this effect. Heavy periods can also occur after using the ‘morning after pill’ (emergency contraceptive) and sometimes after discontinuing birth control pills (oral contraceptive).

Sometimes heavy menstrual bleeding  can be related to other diseases apart from gynecological disorders. This may be seen with thyroid disorders and pelvic inflammatory disease (PID).

The presence of blood clots may only be an indication of heavy periods which is known as menorrhagia. Excessive bleeding during a period may cause the formation of blood clots and this alone is not always a cause for concern unless the heavy bleeding leads to other complications such as anemia. However, if the bleeding is excessive and prolonged and you have been passing large clots too frequently, it would be advisable to consult with your doctor.

What Could Cause Menstrual Clotting?

During a menstrual cycle the uterus prepares itself to receive the fertilized egg if fertilization does occur. If pregnancy has not occurred, the thickened uterine lining mixed with blood is shed and this comes out as menstrual bleeding. These bits of uterine lining and blood clump together and may form clots.

The endometrium of the uterus contains an enzyme called plasmin which prevents the blood from clotting. If there is any problem with secretion of plasmin, blood clots may form in the uterus. Passing clots during menstruation may not be abnormal and usually indicates excessive bleeding, which is quite common in many women. However, heavy bleeding with clots may be due to other reasons as well, such as uterine fibroids, tumors, polyps, cancerous growths, dysfunctional uterine bleeding, adenomyosis, endometriosis or endometrial hyperplasias.

If you are a woman of childbearing age, bleeding in early pregnancy, possibly due to an impending abortion, may be a complication that has to also be kept in mind. In women approaching menopause there is often a change in the menstrual flow and the occurrence of menorrhagia with passage of blood clots is common.

Certain medication can increase chances of clots and women with thyroid problems may also experience menstrual clotting. Any abnormalities or defects in coagulation could lead to excessive clot formation. Intrauterine contraceptive devices (IUD), oral contraceptives and other hormone preparations may also cause menorrhagia and the passage of blood clots.

If your previous periods have been normal and you are now passing big clots, a medical examination is definitely advisable. Your doctor will examine you and will probably advise some tests to confirm or rule out any conditions which might be causing the problem. Treatment, as and when necessary, will help to take care of the problem.

Diagnosing the Cause of Menstrual Clotting

If you are concerned about your menstrual clotting, you should seek medical advice. Your doctor will ask about your periods, their duration, any changes from the previous ones, amount of blood loss, the date of your last menstrual period (to rule out pregnancy and miscarriage) and so on. Many causes of menorrhagia can be identified by the history alone. After taking the history, which will include questions about previous deliveries and any other concerns that you might have, your doctor will do a physical examination which will also include a vaginal examination.

After that, if your doctor thinks it necessary, you may be advised a number of tests such as blood tests (especially to check for clotting defects and anemia), and an ultrasonography to detect any abnormality in your uterus or vagina. A dilatation and curettage (D & C) may be necessary to take samples from your cervix and uterus for testing and a biopsy may also be done. Hysteroscopy can help in diagnosis by direct visualization of the uterus and also by helping to take the biopsy material from the correct site.

What is the Treatment for Menstrual Clotting?

Often menstrual clotting is associated with severe stomach cramping. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may help to relieve the pain as well as reduce blood flow, but you should only take these drugs after consulting your doctor.

Iron supplements may be advised by your doctor if you are suffering from anemia due to excessive blood loss.

If other causes of menorrhagia such as a fibroid, polyp, cancerous growth and so on can be excluded and the bleeding is not as excessive as to be life-threatening, hormone therapy may be tried and often gives good results.

Surgery is a consideration for conditions such as fibroids. A myomectomy can be done to remove the fibroid while preserving the uterus if you wish to have future pregnancies. Hysterectomy (surgical removal of the uterus) may be done for certain conditions such as endometriosis, adenomyosis or dysfunctional uterine bleeding but is advised only if other treatments fail.

A D&C (dilation and curettage) may be done both for diagnosis as well as for treatment of excessive menstrual bleeding with clots.

If IUD is found to be the cause of clotting, it has to be removed. Oral contraceptive pills may need to be changed or discontinued if they are the offending agents.

For small amounts of menstrual clotting you may not need any treatment at all. In all likelihood the clots that you are passing during your periods are not a cause for concern but consulting with your doctor may help to put you at ease and clear up any doubts that you might have.

Periods and coping with them is something which every girl and women will have to do and there are many downsides to having them, while some women will be extremely lucky and only have very light periods for a day or two with no problems some women suffer horrendously for a week with heavy bleeding, severe cramps and a blinding headache.

All of these while being bad are in fact the norm for some women and are just something that has to be put up with and dealt with in the best way possible. Most of the symptoms however stressful they may be are only natural and are nothing more than the menstrual cycle.

The dreaded PMS

PMS or pre menstrual syndrome is basically a name for all the symptoms that many girls and women get on the run up to their period, that’s right not only do they suffer during but also on the lead up to it.

These symptoms can occur up to two weeks before the period starts

• A bloated feeling.
• Fatigue.
• Headaches.
• Sore breasts.
• Constipation.
• Cravings for certain food such as chocolate.Feeling very down.
• Feeling very irritable.
• Feeling stressed.
• A difficulty in concentrating on any one thing.

Eating lots of fruit and vegetables, drinking more water and cutting back on the salt intake are all known to help reduce the symptoms, taking vitamins can also help as can cutting back on the amount of caffeine you drink. Over the counter remedies for the pain such as paracetemol will of course help to relieve the stomach cramps.

What causes the stomach cramps?

Some women get very intense stomach cramps during the run up to their period and throughout their period; these are caused by chemicals in your body causing the muscles of the uterus to contract. As much as we might not feel like it exercise has been know to alleviate the pain, also soaking in a warm relaxing bath might help, this wont make the pain go away but it can cause the muscles to relax a little and relieve it a little. If the cramps are so severe that you miss school or work due to them then seek the advice of your doctor.

What age will I start having periods?

This is a question many young girls ask and everyone will go through puberty at different ages so there is no clear answer, some girls have been known to get their period from as young as 8 years old, others not until they have reached 16. Family has a lot to do with it so ask your mum how old she was when she got her period, the chances are that this will be around the time you will although there is no guarantee.

You shouldn’t really worry about not getting it, though if you have reached the age of 16 and have yet to start then it would be wise to seek the advice of your doctor, other than that enjoy the years you are menstrual free, they wont last.