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).

Causes of Brown to Black Vaginal Bleeding

It is important to ascertain whether the bleeding is related to a menstrual bleed or not. The presence of other symptoms like pain, discharge preceding or during the bleed, blood clots or pieces of tissue in the blood are all significant in identifying the most likely cause. Remember that a small quantity of brown blood towards the end of a menstrual period is not abnormal and is just degraded blood (“old blood”) being expelled.

Retained menses is not a common phenomenon. It may be due to the menses being retained with the uterus or even in the vagina. An imperforate hymen is where the hymen fully rather than partially covers the vagina and at the onset of menstruation during puberty (menarche), the menses cannot pass out of the vagina. In older women, cervical stenosis which is narrowing of the cervix (or more correctly the endocervical canal) either obstructs or drastically slows down the exit of menses from the uterus. There are other possibly causes relating to anatomical abnormalities of the uterus, cervix or vagina but these are usually present from birth (congenital).

A miscarriage is a more common cause of brown to black vaginal bleeding. While it is a consideration in every pregnant woman’s mind, not all woman realize that they are pregnant until there is an abnormally heavy bleed particularly when it is laden with large clots or the color varies significantly from the normal menstrual blood. The products of conception are eventually ejected but sometimes it is retained. This is known as a missed abortion and arises when the cervical os does not dilate to allow for the products of conception to pass out. Over time there is a scanty brown to black bleed that is often foul smelling. This symptom is less common with an elective / induced abortion if it is done by a medical professional since the cervix is dilated and the products of conception may be removed with a D and C.

Infections of the vagina, cervix or uterus may cause brown to black vaginal bleeds at the proteolytic enzymes of the bacteria rapidly degrade the blood. These infections may be sexually transmitted like gonorrhea and chlamydia, commonly caused by rectal bacteria like E.coli or due to overgrowth of the naturally occurring bacteria in the vagina (vaginosis). It is typically associated with a foul smelling discharge, pelvic pain with pain during urination and intercourse and sometimes a fever.

Cancer is a fairly common cause of vaginal bleeding that is not related to menses – intermenstrual bleeding. It is, however, not a common cause of brown to black vaginal bleeding. An ulceration of the reproductive tract may cause bleeding and if the outflow is restricted or complicated with pelvic inflammatory disease (infection) then there may be a dark brown to black vaginal bleed usually presenting as spotting.

Types of Abnormal Bleeding from the Vagina

There are different terms to describe the various types of vaginal bleeding that are considered to be abnormal.

• Metrorrhagia is the term for any bleed that does not occur at the time of menstruation. It is also known as intermenstrual bleeding.
• Menorrhagia is the term for prolonged menses or excessive.
• Polymenorrhea is the term for too frequent menstruation.

Causes of Abnormal Vaginal Bleeding

There are a host of possible causes and abnormal vaginal bleeding should be investigated further by a medical professional. The site of bleeding can be anywhere in genitourinary system and sometimes bleeding from the urethra is mistaken for a vaginal bleed. Some of the causes include :

• Gynecological Disorders
• Cancer of the vagina, cervix, or uterus
• Cervicitis
• Dysfunctional uterine bleeding (DUB)
• Endometriosis
• Foreign body in the vagina
• Injury of the cervix, vagina, or vulva
• Polyps of the cervix or endometrium (uterus)
• Polycystic ovary syndrome
• Uterine fibroids
• Vaginitis

• Non-Gynecological or Systemic Causes
• Hyperprolactinemia
• Hypothyroidism
• Bleeding disorders
• Medication like hormonal contraceptives and hormone replacement therapy.
• Intra-uterine devices (IUDs)

Pregnant Women

Vaginal bleeding is of greatest concern in pregnancy. It may be a sign of a threatened abortion or ectopic pregnancy if it occurs early in pregnancy. In late pregnancy, vaginal bleeding may be due to abruptio placentae or placenta previa which are very serious conditions that require careful monitoring or medical intervention. Sometimes a bleed in late pregnancy may occur with uterine polyps.

Babies and Young Girls

Vaginal bleeding in children is uncommon. When it does occur it infants it may be due to the estrogens from the mother’s circulation crossing the placenta and is then present in the baby after birth. This can cause vaginal bleeding in infants. In older children, vaginal bleeding should always be investigated first for the possibility of sexual abuse. Other causes may include vaginal or cervical warts, foreign bodies in the vagina or tumors. Sometimes puberty may occur at a much younger age than normal and this is known as precocious puberty.

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.

Vaginal bleeding in pregnancy is not always serious. Within the first few days after conceiving, you will experience a little spotting or light bleed. This is known as the implantation bleed and is perfectly normal. Apart from the implantation bleed, mild spotting and light bleeding in early pregnancy can occur with no danger to the mother or child. Some women even experience a light bleed at the time of their period although they are pregnant. However caution in early pregnancy is always advisable and if you are experiencing any vaginal bleeding, speak to your gynecologist.

Causes of Bleeding in Early Pregnancy

The most common cause of vaginal bleeding in early pregnancy is a spontaneous abortion or miscarriage. This may occur for a number of reasons and it is usually associated with abdominal pain. Every pregnant woman is at risk of a miscarriage, especially in the first 12 weeks as this is a very delicate stage in the pregnancy. If you have any of the risk factors associated with a spontaneous abortion, you should be even more weary of any sign of a vaginal bleed. These risk factors include a history of previous miscarriage(s), repeated fertility procedures, cigarette smoking, drug abuse or excessive alcohol consumption during pregnancy, adhesions and uterine fibroids.

Other causes of vaginal bleeding in early pregnancy include a ruptured ectopic pregnancy, which is very dangerous for the health of the mother. Bleeding in early pregnancy may also arise as a result of :

• Trauma – injury, fall, assault.
• Inflammation of the cervix (cervicitis).
• Inflammation of the vagina (vaginitis).
• Rupture of an ovarian cyst.

Other less common causes of vaginal bleeding in early pregnancy will be discussed with you by your gynecologist after he/she has excluded the most serious and common causes.

Warning Signs

Vaginal bleeding in early pregnancy is not uncommon. It should be investigated by your gynecologist or the attending doctor and in many cases, it is not serious. However if there are other signs and symptoms present, a case of vaginal bleeding in early pregnancy should be taken very seriously. These signs and symptoms include :

• Abdominal or pelvic pain with/without tenderness of the abdomen.
• Vaginal discharge that is yellow, brown or almost black or contains spots of blood, especially if there is a smelly vaginal odor.
• Dizziness, light headed feeling and/or fainting spells.
• Changes in blood pressure and or pulse.
• Fever.

Danger in Early Pregnancy

The main danger in early pregnancy is not taking any action when there are signs and symptoms present that should alert you to a possible problem. If you are feeling unwell in your early pregnancy, even if there is no signs or symptoms of any condition, rather consult with your gynecologist and put you mind at ease. While many of the signs and symptoms of pregnancy make a pregnant woman feel unwell, there are other possibilities that could be an indication of complications that could put both you and your baby at risk.

An Ectopic pregnancy is a pregnancy which develops outside of the womb most usually in the fallopian tubes though it can occur in other parts of the reproductive system. Other common sites for the pregnancy to develop are the uterus, cervix, the abdominal cavity and the ovaries.

How does this happen and why? Normally when fertilised the egg will go down the fallopian tubes into the womb, it will then grow in size until it forms what is called the blastocyst, this is what the embryo and placenta will develop from. Within days of conceiving the blastocyst will attach itself to the lining of the womb however if for any reason there is a delay in this happening then the blastocyst will be ready for attachment before it has reached the womb.

This will then more than likely result in an Ectopic pregnancy. There is a risk to the women’s health should they have an Ectopic pregnancy with most of them relating to the fallopian tubes being damaged or altered.

What are the symptoms of Ectopic pregnancy?

Most of the symptoms of Ectopic pregnancy will show very early on in the pregnancy with a lot of Ectopic pregnancies leading to miscarriage; however this is not always the case. However if the Ectopic pregnancy occurs within the abdominal region then it can go on for some time before symptoms begin to show.

During the first 12 weeks symptoms of Ectopic pregnancy will show as vaginal bleeding or spotting and abdominal pain, other symptoms can develop and one in particular should be watched for as this is sometimes a clear sign that the pregnancy is Ectopic and this is dizziness and shoulder tip pain. Both of these symptoms can suggest that there is very heavy internal bleeding and a doctor’s advice should be sought immediately.

How is Ectopic pregnancy confirmed?

The signs and symptoms of Ectopic pregnancy are very similar to those of normal pregnancy and early miscarriage so they hard to pick up on, however your doctor should give your abdomen and pelvis a very careful examination.

A lot of times this examination will also include an internal examination, though if you have suffered from miscarriage in the past your doctor may be inclined not to give you an internal as there is a risk of inducing a miscarriage. If through the examination your doctor thinks your pregnancy may be Ectopic he/she will suggest that you have an ultrasound scan to determine if you are having a normal or Ectopic pregnancy.

What is the treatment for Ectopic pregnancy?

There are basically two methods of dealing with the Ectopic pregnancy, the first of these involves an operation called a laparoscopy and the pregnancy along with surrounding tissue will be removed and the second involves medication by an intramuscular injection.