Painful Periods and Heavy Bleeding

New Patient Appointment or 214-645-8300

Common menstruation problems include heavy bleeding, irregular menstrual bleeding, and abnormally painful periods. UT Southwestern gynecologic surgeons, specialists, and their teams are nationally recognized for their expertise in women’s healthcare. We participate in research to improve diagnosis, management, and treatment for heavy, irregular, and painful periods.

What Is Considered Heavy Bleeding or a Painful Period?

For most women, menstrual cycles occur every 21 to 35 days. Periods typically last two to seven days.

Menstrual bleeding may be considered heavy, or menorrhagia, if it:

Lasts longer than seven days
Soaks through one or more pads or tampons each hour for several hours
Requires more than one product at a time to control bleeding, such as a pad and a tampon
Requires changing pads or tampons during the night
Includes blood clots the size of a quarter or larger
Soaks through to clothing or bedsheets
Causes someone to miss work, exercise, or other daily activities

Severe pain associated with menstruation, or dysmenorrhea, doesn’t improve with over-the-counter pain medication and may get worse over time. It can disrupt daily activities, such as work, school, or exercise.

What Are the Symptoms of Heavy, Painful Periods?

Symptoms of Heavy Menstrual Bleeding

Heavy menstrual bleeding can lead to iron-deficiency anemia, which can cause fatigue and shortness of breath.

Symptoms of Painful Periods

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

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

What Causes 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.
Cancer: Cervical 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.
Polyendocrine metabolic ovarian syndrome (PMOS)/polycystic ovary syndrome (PCOS): PMOS/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.
Primary ovarian insufficiency: 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: This can be caused by PMOS/PCOS or perimenopause.

How Are Painful, Heavy Periods Diagnosed?

Evaluating Heavy, Painful Periods

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.

Testing for Heavy, Painful Periods

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

Blood tests: Look for signs of iron deficiency, thyroid disorders, or blood-clotting abnormalities
Ultrasound: Diagnostic tool that uses sound waves to produce images of the pelvic organs, revealing abnormalities
Pap smear: Sample of cells from the cervix that are examined under a microscope for 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: This examination of the inside of the uterus uses a hysteroscope, a slender, lighted device inserted through the vagina and cervix. This allows direct visualization of the inside of the uterus
Sonohysterography: This test involves injecting fluid into the uterus via a thin tube through the vagina and cervix and then taking ultrasound images of the uterus.

How Are Painful Periods and Heavy Bleeding Treated?

Treatment for Painful Periods

If 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 can also 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 a hormonal intrauterine device (IUD). 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.

Treatment for Heavy Period 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.

Why Choose UT Southwestern for Painful Period and Heavy Bleeding Treatment?

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.

U.S. News & World Report Best Hospitals in Obstetrics & Gynecology

Nationally Ranked in Ob/Gyn

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

What Clinical Trials Are Available for Heavy, Painful Periods?

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.