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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.
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.
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.
We also recommend these free smartphone apps for tracking 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.
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.
Treatment is different for each young woman, but there are some common options. One or more of the following may be used:
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.
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.