Understanding Your Heavy Flow: When To See A Doctor For Excessive Bleeding

We all experience our cycles very differently. You may be someone who typically bleeds for about five days, or someone whose flow lasts eight or nine days or longer. You may be someone who changes your super-mega-extra-strength tampon every one to two hours. What exactly does a heavy flow mean, and should you be concerned?

Read more: Painful Periods: When to See a Doctor

The answer: maybe. You could be experiencing menorrhagia, or a profuse and prolonged period. So how do we know when too much blood is really too much?

Here are some general guidelines: 

• Your period lasts longer than seven days. 
• You're changing a pad or large/super tampon every hour for three or more hours in a single day. 
• You're changing a full menstrual cup three times a day.
• You need to double up on menstrual products to control your flow (e.g., using a pad and tampon at the same time).
• You're waking to change menstrual products during the night. 
• Your period flow stops you from being able to go about your day or prevents you from participating in activities. 
• You see blood clots that are larger than the size of a quarter.

If you relate to any of these symptoms, it’s best to call your doctor. Below we’ve listed some potential causes of menorrhagia so you can ask your doctor informed questions. 

Thyroid Disease & Hypothyroidism

One of the most commonly missed causes of menorrhagia is thyroid disease. Your thyroid produces thyroid hormone, which controls many activities in your body, including how fast you burn calories and how fast your heart beats. Diseases of the thyroid cause it to make either too much or too little of the hormone. Hypothyroidism, when your thyroid does not make enough thyroid hormones, can cause a host of period problems including long periods or a period that won’t stop.

Experiencing any of the symptoms below? These are indicators of thyroid disease and hypothyroidism:

• Fatigue
• Increased sensitivity to cold
• Constipation
• Dry skin
• Weight gain
• Puffy face
• Hoarseness
• Muscle weakness
• Elevated blood cholesterol level
• Muscle aches, tenderness, and stiffness
• Pain, stiffness or swelling in your joints
• Heavier than normal or irregular menstrual periods
• Thinning hair
• Slowed heart rate
• Depression
• Impaired memory
• Enlarged thyroid gland (goiter)

It’s a lot, we know. But it may give you peace of mind to learn about some of the causes of thyroid disease and hypothyroidism:

• Autoimmune disease. The most common cause of hypothyroidism is an autoimmune disorder known as Hashimoto's thyroiditis. Autoimmune disorders occur when your immune system produces antibodies that attack your own tissues. Sometimes this process involves your thyroid gland.
• Over-response to hyperthyroidism treatment. People who produce too much thyroid hormone (hyperthyroidism) are often treated with radioactive iodine or anti-thyroid medications. The goal of these treatments is to get thyroid function back to normal. But sometimes, correcting hyperthyroidism can end up lowering thyroid hormone production too much, resulting in permanent hypothyroidism.
• Thyroid surgery. Removing all or a large portion of your thyroid gland can diminish or halt hormone production. In that case, you'll need to take thyroid hormone for life.
• Radiation therapy. Radiation used to treat cancers of the head and neck can affect your thyroid gland and may lead to hypothyroidism.
• Medications. A number of medications can contribute to hypothyroidism. One such medication is lithium, which is used to treat certain psychiatric disorders. If you're taking medication, ask your doctor about its effect on your thyroid gland.

There’s good news here though - a simple blood draw and thyroid panel can easily clear the air on whether you have a thyroid issue. 

Endometrial Hyperplasia

Endometrial hyperplasia implies the thickening of the uterine wall. If you have endometrial hyperplasia, your uterus is being stimulated to grow too much of the endometrium (what you shed during your period). This disorder most often affects young women who are just beginning to menstruate and older women approaching menopause.

Symptoms of endometrial hyperplasia include:

• Vaginal bleeding between menstrual periods or after menopause
• Heavy menstrual bleeding
• Periods that last longer than usual
• Pain during sexual intercourse
• Amenorrhea (absence of menstrual periods)
• Anovulatory periods (menstrual cycles without ovulation)

Causes of endometrial hyperplasia include:

• An overproduction of estrogen causes endometrial hyperplasia in young women.
• Unopposed estrogen replacement therapy (taking estrogen without progesterone) in postmenopausal women is associated with a higher incidence of endometrial hyperplasia.
• Young women who have just begun to menstruate and women who have (or who have had) irregular menstrual cycles, are at greater risk for endometrial hyperplasia.

Read more: The Elix Guide to Endometriosis

Iron Deficiency Anemia

Iron deficiency anemia is a common type of anemia, a condition in which blood lacks adequate healthy red blood cells to carry oxygen to the body's tissues.

As the name implies, iron deficiency anemia is due to insufficient iron. Without enough iron, your body can't produce enough hemoglobin (the substance in red blood cells that enables them to carry oxygen). As a result, iron deficiency anemia may leave you tired and short of breath.

Iron deficiency anemia signs and symptoms may include:

• Extreme fatigue
• Weakness
• Pale skin
• Chest pain, fast heartbeat, or shortness of breath
• Headache, dizziness, or lightheadedness
• Cold hands and feet
• Inflammation or soreness of your tongue
• Brittle nails
• Unusual cravings for non-nutritive substances, such as ice, dirt, or starch
• Poor appetite, especially in infants and children with iron deficiency anemia

What can cause iron deficiency anemia? A few things…

• Blood loss. Blood contains iron within red blood cells. So if you lose blood, you lose some iron. Women with heavy periods are at risk of iron deficiency anemia because they lose blood during menstruation. Slow, chronic blood loss within the body — such as from a peptic ulcer, hiatal hernia, colon polyp, or colorectal cancer — can cause iron deficiency anemia. Gastrointestinal bleeding can result from regular use of some over-the-counter pain relievers, especially aspirin. You may be noticing that losing blood is causing you to lose more blood. This is a downward spiral that you want to catch.
• A lack of iron in your diet. Your body regularly gets iron from the foods you eat. If you consume too little iron, over time your body can become iron deficient. Examples of iron-rich foods include meat, eggs, leafy green vegetables, and iron-fortified foods. For proper growth and development, infants and children need iron from their diets, too.
• An inability to absorb iron. Iron from food is absorbed into your bloodstream in your small intestine. An intestinal disorder, such as celiac disease, which affects your intestine's ability to absorb nutrients from digested food, can lead to iron deficiency anemia. If part of your small intestine has been bypassed or removed surgically, that may affect your ability to absorb iron and other nutrients.
• Pregnancy. Without iron supplementation, iron deficiency anemia occurs in many pregnant women because their iron stores need to serve their own increased blood volume as well as be a source of hemoglobin for the growing fetus.

Uterine Fibroids

These non-cancerous growths of the uterus often appear during childbearing years. Otherwise known as leiomyomas (lie-o-my-O-muhs) or myomas, uterine fibroids have no association with an increased risk of uterine cancer and almost never develop into cancer. They come in all shapes and sizes, ranging from seedlings to bulky masses that can distort and enlarge the uterus. It’s possible to have one or many fibroids.

The tricky thing about uterine fibroids is many women who have them don’t have any symptoms. In those that do, symptoms can be influenced by the location, size, and number of fibroids. Common symptoms include:

• Heavy menstrual bleeding
• Menstrual periods lasting more than a week
• Pelvic pressure or pain
• Frequent urination
• Difficulty emptying the bladder
• Constipation
• Backache or leg pains

While doctors don't know the cause of uterine fibroids, research and clinical experience point to these factors:

• Genetic changes. Many fibroids contain changes in genes that differ from those in normal uterine muscle cells.
• Hormones. Estrogen and progesterone, two hormones that stimulate the development of the uterine lining during each menstrual cycle in preparation for pregnancy, promote the growth of fibroids. Fibroids contain more estrogen and progesterone receptors than normal uterine muscle cells do. Fibroids tend to shrink after menopause due to a decrease in hormone production.
• Other growth factors. Substances that help the body maintain tissues, such as insulin-like growth factor, may affect fibroid growth.

When to Talk to Your Doctor About Excessive Bleeding

If you relate to any of the causes above, or if you've had periods that last more than seven days — or several days longer than is normal for you—it may be time to talk to a doctor.

The choice is yours, and we’re here to help. If your doctor agrees you’re safe to consume Chinese herbs, Elix’s personalized tinctures of healing botanicals work to balance your body for a more peaceful flow.

Take a few minutes to fill out our online health assessment and learn how your personalized Cycle Balance formula can change the way you experience your period.

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This article was reviewed by Dr. Jessica Ritch.

Dr. Jessica Ritch is a board-certified and fellowship-trained minimally invasive gynecologist who specializes in the management of benign gynecologic conditions such as abnormal bleeding, pelvic pain, fibroids, endometriosis, and polycystic ovarian syndrome. She completed residency training in obstetrics and gynecology at Columbia University, where she was selected as chief resident and received the prestigious AAGL Outstanding Resident in Minimally Invasive Gynecology award.