What You Should Know About Abnormal Uterine Bleeding

At least once during their reproductive years, most women experience bouts of heavy bleeding when they have their period, or menorrhagia. The most common times are during the first few years of menstruation, and then again during the final two to three years before menopause.

A pile of tampons on a table
Image Source / Getty Images

Heavy period blood can be especially alarming if it contains clots. In most cases, though, red, brown, or even black menstrual blood clots are normal—just bits of the endometrium (the lining of the uterus) that are shed during menstruation.

But there are times when menorrhagia is a sign of a problem. Here's what you should know about abnormal uterine bleeding and clotting, including what may be causing the heavy flow and how it can be treated.

Common Causes

What's considered heavy bleeding during menstruation? If you're finding you need to change your pad or tampon more often than every hour or so, or if you're having a period that's been going on for seven days or more, then you may be experiencing abnormal bleeding.

Usually, a hormonal imbalance is to blame. Other causes of abnormal uterine bleeding include:

Women who use intrauterine devices (IUDs) also sometimes have excessive or prolonged periods. If you experience excessive uterine bleeding while using an IUD, it should be removed and you should try another birth control method.

Disorders of the platelets, such as von Willebrand's disease, are the most common blood disorders of excessive menstrual bleeding. These usually are diagnosed soon after a girl starts getting her periods. Women who have von Willebrand's disease commonly will experience not only heavy menstrual bleeding, but also nosebleeds, easy bruising, and blood in the stool.

Often, severe bleeding can be treated with a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen and naproxen. These drugs can help reduce bleeding, in addition to easing the pain of menstrual cramps.

If you experience menorrhagia on a regular basis, you should be monitored closely to make sure your iron levels don't dip. If that happens, you may need to take iron supplements.

Diagnosis and Treatment

The first thing your doctor will do in order to figure out what's causing you to have heavy menstrual bleeding is perform a pelvic exam, including a Pap smear, lab tests and, if appropriate, a pregnancy test. She also may order an ultrasound to check for abnormalities such as fibroids or do an endometrial biopsy, D&C, or hysteroscopy to further evaluate the condition of your uterus.

If it turns out you have fibroids or another condition, your doctor will treat it appropriately. When a hormonal imbalance is a problem, bleeding can be controlled with progesterone or a combination of progesterone and estrogen, often in the form of an oral contraceptive.

Endometrial ablation, once commonly used to treat excessive bleeding in women past child-bearing age who wanted to avoid hysterectomy, has now been replaced by a therapy called thermal balloon ablation. In most cases, thermal balloon ablation ends bleeding by destroying the lining of the uterus. Therefore, it's only appropriate for women who are through having children or are certain they don't want them. However, this procedure does not guarantee one hundred percent protection from pregnancy. Women who do not desire children should continue using their preferred birth control method.

Unless you're pregnant when you experience abnormal uterine bleeding, a single episode of heavy menstrual bleeding usually doesn't require treatment. One exception is if the heavy bleeding lasts for more than 24 hours, in which case you should get in touch with your doctor as soon as possible.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Walker MH, Borger J. Menorrhagia. [Updated 2019 Jan 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536910/

  2. Santos IS, Minten GC, Valle NC, et al. Menstrual bleeding patterns: A community-based cross-sectional study among women aged 18-45 years in Southern BrazilBMC Womens Health. 2011;11(1):26. Published 2011 Jun 7. doi:10.1186/1472-6874-11-26

  3. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Heavy periods: Overview. 2009 Dec 31 [Updated 2017 May 4].Available from: https://www.ncbi.nlm.nih.gov/books/NBK279294/

  4. Davis E, Sparzak PB. Abnormal Uterine Bleeding (Dysfunctional Uterine Bleeding) [Updated 2019 Aug 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532913/

  5. Whitaker L, Critchley HO. Abnormal uterine bleedingBest Pract Res Clin Obstet Gynaecol. 2016;34:54–65. doi:10.1016/j.bpobgyn.2015.11.012

  6. Govorov I, Ekelund L, Chaireti R, et al. Heavy menstrual bleeding and health-associated quality of life in women with von Willebrand's diseaseExp Ther Med. 2016;11(5):1923–1929. doi:10.3892/etm.2016.3144

  7. Farrukh JB, Towriss K, McKee N. Abnormal uterine bleeding: Taking the stress out of controlling the flowCan Fam Physician. 2015;61(8):693–697.

  8. Kolhe S. Management of abnormal uterine bleeding - focus on ambulatory hysteroscopyInt J Womens Health. 2018;10:127–136. Published 2018 Mar 22. doi:10.2147/IJWH.S98579

  9. Maybin JA, Critchley HO. Medical management of heavy menstrual bleedingWomens Health (Lond). 2016;12(1):27–34. doi:10.2217/whe.15.100

  10. Bouzari Z, Yazdani S, Azimi S, Delavar MA. Thermal balloon endometrial ablation in the treatment of heavy menstrual bleedingMed Arch. 2014;68(6):411–413. doi:10.5455/medarh.2014.68.411-413

  11. Elmaoğulları S, Aycan Z. Abnormal Uterine Bleeding in AdolescentsJ Clin Res Pediatr Endocrinol. 2018;10(3):191–197. doi:10.4274/jcrpe.0014

Additional Reading