A couple heavy flow days at the beginning of your period is normal. We’ve all leaked through a tampon or noticed a couple blood clots on our pads at the end of the day.

But if you change your sheets in the morning because you bleed through your tampon or pad at night, avoid wearing light-colored clothing during your cycle or cram your purse full of tampons, you could have chronic heavy periods, also known as menorrhagia.

But what may be causing your heavy periods? How can you tell the difference between normal and heavy menstrual bleeding? And what treatments are available for heavy periods? Below, we answer all those questions and more.

What is considered menorrhagia?

Menorrhagia is a general term for heavy or prolonged menstrual bleeding, and about one in five women experience it. Since everyone is different, it can be tricky to know if what you think is “normal” for your cycle would be considered a heavy period. In fact, half of women who experience menorrhagia don’t actually know they have it.

Signs that you’re losing excessive blood during your period

The best way to figure out if you’re experiencing chronically heavy period bleeding is to talk to a doctor. But there are some general signs that point toward menorrhagia. According to the American College of Obstetricians and Gynecologists, any of the following is considered a symptom of heavy menstrual bleeding:

• Bleeding for more than seven days
• Bleeding through one or more tampons or pads every hour
• You need to change your pad or tampon during the night
• You need to double up on protection to keep from leaking
• You notice large blood clots during your period (the size of a quarter or bigger)

If left untreated, heavy period bleeding can also lead to anemia, which is when you don’t have enough red blood cells to circulate the amount of oxygen your body needs. This can cause other physical symptoms, such as:

• Fatigue
• Lightheadedness
• Shortness of breath

There are many different causes of heavy menstrual bleeding. The good news is that most of these causes are treatable. Because each woman’s period is unique, seeing the doctor is the only way to know for sure what’s causing your heavy periods. The most common causes of heavy periods include:

• Life changes – Our bodies are sensitive to change. Even stress can cause abnormal periods. So it shouldn’t come as a surprise that big life changes may affect your cycle. It’s common to experience heavy period flow after pregnancy or childbirth, or during the time your body transitions to menopause (perimenopause).
• Changes to your medications or birth control – Heavy periods are a side effect of some medications, especially blood thinners. And some forms of birth control can affect the length of your menstrual cycle and how much you bleed. For example, using a copper or hormonal intrauterine device (IUD) can cause heavier periods for 3-6 months. Talk to your doctor if you notice changes to your period after starting a medication or birth control.
• Hormone imbalance – Too much or too little estrogen and progesterone can cause menorrhagia. Some women experience high levels of estrogen and low levels of progesterone. This can cause the uterine lining to thicken. When a thick uterine lining sheds during menstruation, women might experience heavier blood flows and larger blood clots.
• Uterine fibroids – Uterine fibroids are small, non-cancerous growths inside the uterus. One of the most common symptoms of uterine fibroids is heavy bleeding. If your doctor finds fibroids in your uterus, they might recommend treatment options for uterine fibroids, including procedures to remove them.
• Endometriosis – Endometriosis is a painful condition that causes abnormal growth of the uterine lining and forms uterine polyps. It can cause short period cycles and heavy, painful periods as your body sheds the thickened uterine lining. About one in 10 women in the United States has endometriosis.

How is heavy menstrual bleeding diagnosed?

Diagnosing menorrhagia has two parts: confirming that your bleeding is unusually heavy and identifying the underlying cause.

For the first part, your doctor will ask you questions about your medical and menstrual histories. For the second part, one or more tests may be used. Examples include:

• A blood test to check hormone levels and look for signs of anemia or clotting issues.
• A Pap test, where cells from your cervix are examined for signs of infection, inflammation or other unusual changes.
• An endometrial biopsy, which involves taking samples from your uterine lining. The samples are looked at to see if any unusual or cancerous cells are present.
• An ultrasound, which uses sound waves to check for dysfunction in the pelvic organs, as well as blood flow issues.
• A sonohysterogram, another kind of ultrasound that’s done while your uterus is filled with liquid to get a better look at the uterine lining.
• A hysteroscopy, where a very small, flexible camera is used to examine the uterus for fibroids, polyps and other possible causes of bleeding issues.

How to stop heavy periods

Knowing the underlying reason for your heavy periods is key to getting the treatment that will be most effective for you, which is why talking to a doctor is so important. In some cases, heavy menstrual bleeding caused by fibroids, growths or endometriosis are best treated through surgery. But most often, menorrhagia treatment is a matter of lifestyle changes and medication.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can lighten bleeding

Select NSAIDs like ibuprofen can reduce pain caused by menorrhagia and make your periods lighter. This is because NSAIDs reduce the amount of prostaglandins – hormones that cause pain and bleeding – in your uterine lining. While ibuprofen is helpful, some NSAIDs like aspirin that have blood-thinning effects should not be used for this purpose, as they may make bleeding worse.

Birth control and hormone therapy can regulate periods

Pills, patches, hormonal IUDs and other forms of hormonal birth control can help regulate your periods. Hormonal birth control can thin the uterine lining, which reduces the amount of blood and tissue you lose during your menstrual cycle. Birth control can also be used to regulate the length of your cycle, alleviate painful cramps or even as a way to stop your period altogether. If you’re entering perimenopause or menopause, birth control can help manage menopause symptoms.

Similarly, hormone therapy can be used to thin the uterine lining and correct hormonal imbalances. Hormone therapy can also be used to treat conditions like endometriosis that cause pain and menstrual bleeding.

Other medicines can help, too

In some cases, other medicines that require a doctor’s prescription can be used to help treat menorrhagia symptoms. Examples include stronger NSAIDs, tranexamic acid and desmopressin. Tranexamic acid can be taken at the start of a menstrual period to reduce bleeding, and desmopressin reduces bleeding by helping blood clot.

Diet changes can reduce side effects of heavy periods

Although it won’t stop menorrhagia, eating a diet rich in iron can help prevent anemia. Iron-rich foods include meat, seafood, beans, nuts, seeds and leafy green vegetables. Eating foods with lots of vitamin C like oranges, bell peppers and broccoli can help your body absorb extra iron in your diet. Also, do your best to avoid foods with processed sugar, trans-fats and starchy carbs. These foods can make menorrhagia symptoms worse. If you’re unable to get enough iron through food, your doctor may recommend an iron vitamin supplement.

Heavy periods aren’t something that you have to put up with. If your period affects your daily life by causing you to miss work or school, cancel social activities or plan your day around bathroom breaks, make an appointment with a women’s health expert or a primary care doctor. At HealthPartners, you can choose from in-person or video visit options.

Women’s health experts like OB-GYNs specialize in female reproductive health, including heavy periods. And primary care doctors can diagnose and treat hundreds of conditions, as well as connect you with a specialist if more advanced care is needed.