Children's Hospital Colorado

Heavy or Abnormal Menstrual Bleeding

What is heavy or abnormal menstrual bleeding?

Menstrual periods are considered heavy or abnormal if a young woman has periods that last longer than eight days in a row. It also includes bleeding that occurs more often than every three weeks and requires changing a pad or tampon every hour or less than an hour during menstruation. Heavy menstrual bleeding may also cause fatigue, dizziness or other signs of anemia.

What causes heavy or abnormal menstrual bleeding?

In girls and young women, heavy or abnormal menstrual bleeding most often occurs because of an imbalance of hormones. The body produces a female hormone called estrogen at the beginning of puberty. Estrogen causes the lining of the uterus to grow thicker. The body also makes a hormone called progesterone after ovulation. Progesterone causes the lining of the uterus to mature and thin over time.

For many girls and young women, ovulation does not occur regularly in the first several years after getting their first period. Without monthly ovulation, the lining of the uterus grows thicker due to the presence of estrogen without the balance of progesterone. This causes irregular, frequent, heavy and prolonged periods.

Another much less common cause of heavy bleeding is a bleeding disorder, which means the blood is not clotting as it should. Structural problems like fibroids, polyps or other growths are rarely the cause of bleeding in girls and young women.

Who gets heavy or abnormal menstrual bleeding?

Heavy menstrual bleeding due to hormonal factors is more common in the first few years after getting a menstrual period. This is because it often takes several years for girls to have regular and monthly ovulatory cycles.

Heavy menstrual bleeding due to a bleeding disorder is often due to an inherited or genetic condition. Let your doctor know if there is a family history of heavy bleeding in any close relative like siblings, mother or father.

Helpful resources

We also recommend these free smartphone apps for tracking menstrual bleeding:

  • Search “Sisterhood” in the app store. You can find information at the Sisterhood website.
  • Search “Clue” in the app store. You can find information at the Clue website.

What are the signs and symptoms of heavy or abnormal menstrual bleeding?

  • Periods last longer than eight days in a row
  • Bleeding happens more often than every three weeks
  • Soaking a pad or tampon every hour for more than two to three hours in a row
  • Passing large blood clots (larger than the size of a quarter) and frequently bleeding onto clothes and bed sheets
  • Fatigue, shortness of breath, dizziness or other signs of anemia

What tests are used to diagnose abnormal menstrual bleeding?

Testing for causes of abnormal menstrual bleeding will start with a blood test. This will include a complete blood count (CBC) that tests for anemia. If there is significant anemia, then the doctor may recommend additional screening for a bleeding disorder. In most cases, abnormal or heavy menstrual bleeding in girls and teens is due to a hormone imbalance. The doctor may recommend additional testing based on your specific history and concerns.

Why choose Children’s Colorado to evaluate heavy menstrual bleeding?

Our adolescent gynecologists have extensive experience in evaluating girls and teens with heavy bleeding. We’ll take the time to interpret and clearly explain test results to you and your daughter. When needed, we also work closely with our hematologists who specialize in bleeding disorders.

How is heavy menstrual bleeding treated?

Treatment is different for each young woman, but there are some common options. One or more of the following may be used:

  • Anemia: If anemia (low hemoglobin) or low iron stores (ferritin) is found, the doctor will recommend you start taking an iron supplement and continue until your anemia and iron stores have returned to normal.
  • Hormone imbalance: Treatment with hormonal medicine helps to stabilize the lining of the uterus. Birth control pills, the patch or vaginal ring may be recommended, not for the purpose of birth control, but to provide the hormones your body needs to stabilize the lining of the uterus. Hormonal medicine can include:
    • Oral progesterone (usually norethindrone acetate)
    • A combination of birth control pills and norethindrone acetate
    • A progesterone-containing intrauterine device (IUD)
    • A progesterone-containing implant
    • Depo-Provera injection
  • Bleeding disorders: For girls with diagnosed bleeding disorders, we will work closely with our hematologist to ensure that the most effective treatments are offered.

In cases of very heavy bleeding, the doctor may offer treatment with tranexamic acid (a non-hormonal alternative medicine). The doctor may also recommend ibuprofen to help relieve cramps and decrease the amount of bleeding.

Why choose Children’s Hospital Colorado for your child’s heavy or abnormal menstrual bleeding?

Our board-certified pediatric and adolescent gynecologists have specialized training in the reproductive health concerns of girls of all ages. We understand the complex changes that occur during puberty. We can recognize both common and rare causes of heavy menstrual bleeding in girls, teens and young women.

We will put both you and your daughter at ease by carefully explaining her medical condition and then discussing the various options for treatment. We will support your family with follow-up appointments and/or consultation with your primary care doctor as needed.


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