Heavy or Abnormal Menstrual Bleeding

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 Hospital Colorado to evaluate heavy menstrual bleeding?

Our adolescent gynecologists have extensive experience in evaluating girls and teens with heavy bleeding. We 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.

• 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 Colorado for your daughter'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.

• Overview of menstrual problems and treatments at Children's Colorado Pediatric and Adolescent Gynecology
• The Young Women's Bleeding Clinic at Children's Colorado
• Bedsider provides accurate information on contraceptive methods, which are commonly used to manage abnormal or heavy bleeding, even when there is no need for birth control.
• The Foundation for Women & Girls with Blood Disorders provides information on bleeding disorders.

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.