Top 5 Reasons for Excessive Menstrual Bleeding
- Written by Jing J.
Excessive menstrual bleeding is not only unpleasant and inconvenient, but it can also lead to chronic, severe anemia and other serious health consequences. So if your periods are heavier than normal, you need to identify the underlying causes and seek remedies as soon as possible.
What is Considered a Heavy Period
We don’t lose as much blood as many of us may think. The average blood loss during a menstrual cycle is 30-80 ml, which is about 2-6 tablespoons.
If your bleeding is more than 80 ml (roughly 16 soaked sanitary pads or tampons) per menstrual period, or the bleeding is heavy enough to interrupt your normal activities, you may be suffering from what’s known as menorrhagia (a heavy period).
5 Most Common Causes of Heavy Period
Below are the five most common causes of heavy menstrual bleeding:
#1 Cause of Heavy Periods: Estrogen Dominance and Progesterone Deficiency
During each menstrual cycle, estrogen is produced to develop a mature egg and thicken the endometrial lining in preparation for ovulation.
Upon ovulation, progesterone is released to help with the implantation of a fertilized egg (if there is one) and the thinning and shedding of the endometrial lining, if an implantation does not take place.
This is the normal ovulatory cycle.
If there’s a disruption along the way and ovulation does not occur due to various reasons, the ovaries will not release progesterone.
Without the counterbalancing effect of progesterone, the endometrial lining can grow excessively due to elevated estrogen levels.
A thicker than normal endometrial lining means there’s more to shed (and more bleeding).
Correspondingly, heavy menstrual bleeding is often associated with too much estrogen and/or too little progesterone.
For this reason, heavy menstrual flow is most common in the teens and in perimenopause – both are times of the lifecycle when ovulation is irregular and consequently estrogen levels tend to be higher and progesterone level to be lower.
However, heavy bleeding caused by this type of hormonal imbalance can also occur during other times of a woman’s lifecycle due to other factors at play.
Check out the 5 leading causes of estrogen dominance and the 6 primary reasons for progesterone deficiency.
#2 Cause of Heavy Periods: Uterine Fibroids and Polyps
Fibroids are benign tumors of the uterus; polyps are small, benign growths on the lining of the uterus.
These extra growths – often related to elevated estrogen levels during the childbearing age – can cause heavy or prolonged menstrual bleeding.
Fibroids are very common. One study found that 80-90% of African American women and 70% of Caucasian women will develop fibroids by age 50.
Among them, about 30% have symptoms of fibroids, per National Institute of Health.
#3 Cause of Heavy Periods: Endometriosis or Adenomyosis
Endometriosis is a disorder in which the tissue that lines the inside of the uterus – the endometrium – grows outside the uterus (e.g., in the ovaries, fallopian tubes or the tissue lining the pelvis).
Adenomyosis is a similar condition in which glands from the endometrium become embedded in the uterine muscle.
Normally the endometrial lining is shed with each menstruation. When it’s trapped in other places, it has no way to exit the body. This can cause severe period pain as well as heavy menstrual bleeding or bleeding between periods.
Endometriosis affects 176 million women worldwide, and 1 in 10 women in the United States. It usually produces symptoms during reproductive years though many women remain undiagnosed.
Adenomyosis was present in 206 of 985 (20.9%) women included in one study. Women with adenomyosis typically first experience symptoms when they are between 40 and 50, but symptoms can occur in younger women as well.
#4 Cause of Heavy Periods: PCOS
Polycystic Ovarian Syndrome (PCOS) is a hormonal disorder that affects 5-10% women of reproductive age in the U.S. (roughly 5 million).
In PCOS, the ovaries develop many small follicles and fail to release eggs regularly. The disruption of the normal ovulatory cycle creates an imbalance of sex hormones (higher male hormone androgen and lower progesterone).
Sometimes these follicles release sufficient estrogen to thicken the endometrial lining. But without ovulation and the release of progesterone (which thins the lining), the lining grows thicker and thicker, leading to heavy, frequent, or prolonged periods.
At other times when the small follicles do not produce enough estrogen to thicken the endometrial lining, there may be no periods at all.
So irregular periods are one of the most common signs of PCOS. Women with PCOS often have fewer than 9 periods a year.
#5 Cause of Heavy Periods: IUD
An IUD is a T-shaped device that’s inserted into the uterus for birth control. 6.4% of American women aged 15-44 choose an IUD as their contraceptive of choice, per the Centers for Disease Control and Prevention.
There are two types of IUDs: Copper IUDs (plastic devices wrapped in coiled copper), and hormone IUDs (containing progestin like birth control pills).
Heavy menstrual bleeding is a well-known side effect of copper IUDs. (Hormone IUDs tend to make periods lighter.)
When a copper IUD is inserted into the uterus, it releases copper which is toxic to the sperm. This triggers an inflammatory response, creating a hostile environment for the egg and sperm (for birth control).
Unfortunately, this additional stress on the uterus can produce heavier or irregular periods, as well as increased menstrual cramping and backaches.
The situation may last for 3-6 months after insertion, until the uterus gets used to having a foreign object in the body.
If your period doesn’t regulate itself within 6 months, you should follow up with your doctor to identify the other possible causes.
Less Common Causes for Heavy Menstrual Bleeding
Above are the five leading causes of heavy menstrual bleeding. Other less common causes include:
- Pregnancy complications, such as a miscarriage or an unusual location of the placenta;
- Medications or herbs that thin the blood (e.g., anti-inflammatory and anti-coagulants);
- Uterine cancer and cervical cancer (especially when heavy menstrual bleeding occurs after menopause or with an abnormal Pap test);
- Medical conditions, such as inherited bleeding disorders (e.g., von Willebrand’s disease), kidney or liver diseases, etc.
When you have heavy, prolonged or abnormal (in between periods) menstrual bleeding, take it seriously.
Go to see your gynecologist to rule out the possibility of fibroids, endometriosis, PCOS, or other more serious medical conditions.
Then you need to do all you can to lower estrogen dominance and boost your progesterone level because heavy menstrual bleeding is most often associated with an imbalance between these two female hormones that regulate our menstrual cycles.
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