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Educational Video
What are heavy periods?
"Heavy periods" (the medical word is menorrhagia) means bleeding that is very heavy or lasts a long time.
Many teens are still learning what a normal period is for them, so it can be hard to know what counts as "heavy."
Different products can be used for menstrual hygiene. These include pads, tampons, period underwear, menstrual cups, and menstrual discs. In this article, "product" means whichever one you use.
Your period may be too heavy if you have any of these:
Bleeding lasts more than 7 days.
You soak through a pad or tampon in less than 2 hours, or fill a cup or disc that fast, for a few hours in a row.
You need to use two products at once (like a pad and a tampon) to stop leaks.
You have to change or empty your product during the night.
You pass blood clots (lumps) the size of a quarter or larger.
Heavy bleeding keeps you from doing your normal activities, like school or sports.
You feel tired, weak, or short of breath with your period.
Why do heavy periods matter?
Heavy bleeding that is not treated can get in the way of your life.
It can also cause anemia. Anemia is a common blood problem that can make you feel tired or weak.
What causes heavy periods?
Sometimes the cause cannot be found. But in teens, some causes are more common than others.
Some of the most common causes are:
Not releasing an egg each month (not ovulating).
This is the most common cause in teens.
In the first few years after periods start, the body often does not ovulate on a regular schedule.
When you do not ovulate, the lining of the uterus builds up and can cause heavier bleeding.
Hormone problems.
These include thyroid problems, PMOS (polyendocrine metabolic ovarian syndrome, formerly known as PCOS or polycystic ovarian syndrome), and having a higher body weight.
These keep the blood from clotting the way it should.
Sometimes a heavy period is the first sign.
Examples are von Willebrand disease and problems with platelets.
Infections, such as pelvic infections or sexually transmitted infections (STIs).
Growths in the uterus, such as fibroids or polyps. These are usually not cancer. Cancer is a very rare cause in teens.
Some medicines, such as certain types of birth control, anti-inflammatory drugs, or "blood thinners" (medicines that prevent blood clots).
Pregnancy problems. If there is any chance you could be pregnant, heavy bleeding can be a sign of a serious problem, like a miscarriage.
What tests might you need?
Your provider will help to decide if you need any tests. This depends on your age, your symptoms, and your own situation. You may not need any tests.
First, your provider will ask about your health, your family's health, your periods, and your medicines. They may also do a physical exam, and a pelvic exam if it is needed.
Your provider may ask to talk with you alone for part of the visit. This is normal. It helps you get comfortable talking about your health and lets you ask private questions. What you share is kept private, while keeping you safe.
Common tests include:
Blood tests — to check for low iron (anemia), a bleeding disorder, thyroid or other hormone problems. This is the most common test.
Ultrasound — a painless test that uses sound waves to make a picture of the uterus and ovaries. It can show fibroids or other growths.
If needed, your provider may also refer you to a specialist, such as a gynecologist (a doctor for the reproductive system) or a hematologist (a doctor for blood problems).
How are heavy periods treated?
Treatment depends on what is causing the bleeding, how heavy it is, and what matters to you.
Your clinician will also think about your age, your health, and your future plans.
You might not need any treatment. Most teens can be treated with medicine. If you do need treatment, options include:
Iron — if blood tests show low iron (anemia).
Anti-inflammatory medicines, such as ibuprofen or naproxen (brand names: Motrin, Advil, Aleve). These can lower bleeding and ease cramps.
Birth Control that has hormones. These can make periods lighter, more regular, or stop them. They come as:
Learn more about different birth control options here and here.
Progesterone (progestin) medicine — to balance hormones and lower heavy bleeding.
Tranexamic acid — a prescription medicine you take only during your period to lower bleeding.
When is heavy menstrual bleeding an emergency?
Call your provider or go to the emergency room if:
You soak through 2 pads or tampons in 1 hour, for 2 hours in a row (or fill a cup 2 times in 1 hour, for 2 hours in a row).
There is any chance you could be pregnant. Bleeding during pregnancy can be a sign of a serious problem.
When should you call your CPCMG primary care provider?
Call your CPCMG primary care provider if you:
Are bothered by your bleeding
Have periods that last more than 7 days
Soak or fill your period product every 1 to 2 hours during your period
Need two products at the same time because you bleed so much
Have to change or empty your product during the night
Pass blood clots larger than a quarter
Bleed in between periods
Get your period more often than every 21 days or less often than every 45 days.
Have any chance of being pregnant
Also call if you have heavy bleeding plus signs of low iron (anemia), such as:
Feeling weak or very tired
Headaches
Trouble breathing when you exercise
A fast or pounding heartbeat
📚 References
This content was adapted from HealthyChildren.org, The American Academy of Pediatrics Parenting Website, Rady Children’s Health Library, CDC, ACOG.
Reviewed by AR DO, JW MD, Patient Education Committee.