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Menstruation: Heavy Bleeding (Menorrhagia)


An in-depth report on the causes and treatment of heavy periods.

Alternative Names

Bleeding: menstrual; Menstrual Disorders


An estimated 10% of all women in their reproductive years have chronic gynecologic problems. Nearly 30% of women reporting such problems spend one or more days in bed per year because of them. In a 2002 survey, women who reported heavy menstrual bleeding to their doctor tended to do so because it interfered significantly with their lives.


Menorrhagia is the most common cause of anemia in premenopausal women. According to one report, 10% of women in their reproductive years have iron deficiencies, and between 2% and 5% have iron levels low enough to cause anemia. Although poor diets play a role in many cases, the problem is compounded in women who have heavy periods. A 2001 study further reported that women with a history of taking nonsteroidal anti-inflammatory drugs (NSAIDs) and antacids have a higher risk for anemia. NSAIDs are agents sometimes used to reduce menstrual pain or heavy bleeding.

Most cases of anemia are mild. Nevertheless, even mild anemia can reduce oxygen transport in the blood, causing fatigue and a diminished physical capacity. (In fact, some studies indicate that even iron deficiency without anemia can produce a subtle but still lower capacity for exercise.) Moderate to severe iron-deficiency anemia is known to reduce endurance.

Moderate to severe anemia can also cause shortness of breath, rapid heart rate, lightheadedness, headaches, ringing in the ears (tinnitus), irritability, pale skin, restless legs syndrome, and mental confusion. Heart problems can occur in prolonged and severe anemia that is not treated. Pregnant women who are anemic, particularly in the first trimester, have an increased risk for a poor pregnancy outcome.

Accompanying Conditions

Pain. Heavy bleeding is often accompanied by menstrual cramps, particularly if the bleeding is caused by uterine fibroids. [For more information, see Well-Connected Reports #100, Dysmenorrhea or Report #73 Uterine Fibroids.]

Infertility. Some conditions associated with heavy bleeding, such as ovulation abnormalities, fibroids, or endometriosis, are important contributors to infertility.

Toxic Shock Syndrome and Infection

Women with heavy periods may use two tampons at a time and are at risk for pushing one in so far that it becomes impossible to retrieve without professional assistance. Keeping tampons in for more than six hours increases the risk for infection. Of particular concern is toxic shock syndrome (TSS), a potentially life-threatening condition caused by bacteria that adhere to tampons and begin producing toxins. Symptoms include very high fever, diarrhea, sore throat, and extreme weakness. A peeling rash may develop, usually on the hands and feet. Blood pressure drops to dangerous levels. TSS now occurs rarely.


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