Painful Periods and Heavy Bleeding

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UT Southwestern Medical Center is recognized by U.S. News & World Report as one of the nation's top hospitals for obstetrics and gynecology care.

UT Southwestern specialists have extensive experience in diagnosing the causes of irregular menstrual bleeding. For women who experience heavy bleeding and painful periods, our specially trained gynecologists can determine if there is a cause for concern.

Expert Management for Painful Periods and Heavy Bleeding

For most women, menstrual cycles occur about every 28 days, and periods last four to seven days. Abnormal menstruation includes problems such as heavy bleeding, known as menorrhagia, irregular menstrual bleeding, and pain during periods, known as dysmenorrhea.

UT Southwestern gynecologic surgeons, specialists, and their teams are nationally recognized for their expertise in women’s health care. We participate in research to improve diagnosis, management, and treatment for heavy, irregular, painful periods. Our specialists are also faculty members, dedicated to educating future women’s health doctors and other care providers.

Causes of Painful Periods and Heavy Bleeding

Some common reasons for irregular, heavy, and painful periods include:

  • Adenomyosis: Endometrial tissue, which normally lines the inside of the uterus, grows into the muscle wall of the uterus
  • Bleeding disorders: Certain inherited bleeding disorders, such as von Willebrand’s disease, which prevents blood from clotting properly, can cause abnormal bleeding
  • CancerCervical cancer and uterine cancer can cause heavy menstrual bleeding
  • Endometriosis: Endometrial-like tissue grows on the outside of the uterus or on the ovaries, fallopian tubes, or other nearby organs
  • Medications: Certain anticoagulants (blood thinners), anti-inflammatory medications, or hormonal medications can lead to heavy menstrual bleeding
  • Polycystic ovary syndrome (PCOS): PCOS is a hormonal disorder that can cause small cysts, or fluid-filled sacs, to develop in the ovaries, causing irregular periods
  • Pregnancy complications: A miscarriage or ectopic pregnancy can cause heavy bleeding
  • Premature ovarian failure: This condition occurs when a woman’s ovaries stop working before age 40, leading to irregular periods and possible infertility
  • Uterine fibroids: Noncancerous tumors made up of muscle tissue can grow in the walls of the uterus, the lining inside the uterus (endometrial cavity), or on the outside of the uterus
  • Uterine polyps: Overgrowth of endometrial tissue can form growths called polyps inside the uterus
  • Hormonal imbalances: Can be due to PCOS or is often related to the perimenopausal period when normal cycles in monthly hormones become out of balance

Symptoms of Painful Periods and Heavy Bleeding

Signs and symptoms of heavy menstrual bleeding include:

  • Bleeding for more than seven days
  • Bleeding that soaks through one or more tampons or pads every hour for several hours in a row
  • Need to use multiple pads to control menstrual flow
  • Need to change pads or tampons during the night
  • Menstrual flow with blood clots larger than a quarter
  • Flooding of clothing and bedsheets with menstrual bleeding
  • Symptoms of anemia, such as fatigue and shortness of breath

Symptoms of menstrual pain include:

  • Diarrhea
  • Headaches
  • Lower back pain
  • Nausea
  • Pain that starts a few days before the period, worsens during the period, and lasts two to three days after the period ends
  • Throbbing or cramping pain in the lower abdomen that can be intense
  • Lower back pain during menses

Patients should see their doctors if:

  • Their periods stop for more than 60 days
  • Their periods become erratic
  • Their periods are less than 21 days or more than 35 days apart
  • They bleed between periods
  • They bleed after sex
  • They have any vaginal bleeding after menopause
  • They suddenly get a fever and feel sick after using tampons

Diagnosis of Painful Periods and Heavy Bleeding

UT Southwestern’s experienced gynecologists conduct a thorough evaluation, which includes a:

  • Physical exam
  • Review of personal medical history, including details of the patient’s menstrual cycle
  • Discussion of symptoms

Patients should bring information about the dates and lengths of their last several periods. For sexually active patients, a pelvic exam will be performed to check for infections and to examine the cervix.

To diagnose heavy bleeding and painful periods, our doctors usually recommend one or more tests, such as:

  • Blood tests to look for signs of iron deficiency, thyroid disorders, or blood-clotting abnormalities
  • Ultrasound: Diagnostic tools that use sound waves to produce images of the pelvic organs. Used to look for any abnormalities  
  • Pap smear: Sample of cells from the cervix that are examined under a microscope for infection or changes that can lead to cancer or already are cancerous
  • Endometrial biopsy: A test that samples a small amount of endometrial tissue for examination under a microscope
  • Magnetic resonance imaging (MRI) scans: Equipment that uses a large magnet and radio waves to produce detailed images of pelvic organs

Based on the results of these tests, we might recommend further testing, such as:

  • Hysteroscopy: Examination of the inside of the uterus using a hysteroscope, a slender, lighted device inserted through the vagina and cervix. This allows direct visualization of the inside of the uterus
  • Sonohysterography: Test that involves injecting fluid into the uterus via a thin tube through the vagina and cervix and then taking ultrasound images of the uterus

Treatment for Painful Periods and Heavy Bleeding

Painful Periods

If the painful periods are not relieved with over-the-counter medications or start to interfere with daily activities, our physicians might be able to offer relief.

Our doctors might recommend:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). If over-the-counter NSAIDs such as ibuprofen (Advil or Motrin) or naproxen (Aleve) don’t relieve symptoms, prescription NSAIDs might be prescribed.
  • Hormonal birth control. Birth control prescriptions contain hormones that can help regulate hormone levels throughout the month and reduce the severity of menstrual cramps. In addition to pills, these hormones also can be delivered by an injection, a patch, an implant placed under the skin of the arm, or a flexible ring that is inserted into the vagina. Another good option, even in teens, is an intrauterine device (IUD) that contains a hormone called progesterone. These methods can be very effective in managing symptoms, even if patients are not sexually active.
  • Surgery. If painful periods are caused by polyps or fibroids, surgical removal of the abnormal tissue can help reduce the symptoms. Many uterine-sparing, fertility-sparing, and definitive surgical options exist to help with these symptoms.

Heavy Bleeding

Our treatment for heavy bleeding is based on the amount of bleeding. Many approaches involve hormone therapy and other nonhormonal medical therapies. If there is a reason estrogen should not be prescribed, an oral progestin might be recommended. Over-the-counter treatments such as ibuprofen can help decrease the amount of bleeding and pain, as well.

Clinical Trials

As one of the nation’s top academic medical centers, UT Southwestern offers a number of clinical trials aimed at improving screening, diagnosis, and treatment of painful periods and heavy bleeding.

Clinical trials often give patients access to leading-edge treatments that are not yet widely available. Eligible patients who choose to participate in one of UT Southwestern’s clinical trials might receive treatments years before they are available to the public.