Occasionally menstrual flow seems heavier than usual, or a period lasts longer than normal. In general, there is little cause for concern unless you find it necessary to use at least two extra sanitary pads or tampons a day. That means you have lost almost 3 ounces of blood over the course of a period. You should also see your doctor if a period lasts more than seven days, or two periods are spaced less than 21 days apart. Heavy or lengthy uterine bleeding occurring at regular intervals is usually a sign of an underlying physical problem.

When you go to the doctor, he or she will want to know about the frequency and amount of the bleeding, whether it's accompanied by pain or blood clots, what type of contraception you use, and whether you bruise easily or bleed often from places other than the uterus. The doctor will also do a number of tests. Urine and stool testing can detect possible problems in the urinary tract, stomach, and intestines that might cause the bleeding. If you are in your childbearing years, you should also have a pregnancy test, a Pap smear (if you haven't had one in 12 months), a biopsy of the endometrium, and a test for ovulation. If you are not ovulating, the doctor will usually perform a D&C of the endometrium.

In addition, if the physician suspects the bleeding stems from inflammation of the vagina, cervix, endometrium, or fallopian tubes, he or she will perform an internal exam, take a blood count, and may take tests for sexually transmitted diseases.

Causes and Cures

Tumors of the pelvic organs could be at fault. Fibroid tumors in the uterus are rarely cancerous but may cause heavy periods. Although small fibroids usually need no special treatment, your doctor may want to remove them. Removal of the entire uterus may be necessary if the fibroids are large or rapidly growing.

Endometrial cancer is another possible cause. Although this disease usually strikes after menopause, every women over 35 with heavy bleeding should be tested. If the test is positive, a complete hysterectomy (removal of the uterus, ovaries, and fallopian tubes) followed by radiation is the usual treatment.

Polyps. Polyps, small growths attached to the wall of the uterus, can also cause excessive bleeding. Because there is a slight risk that the polyps will become malignant, especially after menopause, they are often removed.

Excessive estrogen production, combined with lack of progesterone, can cause continuous stimulation and overdevelopment of the endometrium, leading to heavy bleeding in both adolescence and the premenopausal years. To correct the condition, your doctor may prescribe progesterone to stop the bleeding. When periods become normal, one or two weeks on Provera each month for two or three months should promote shedding of the endometrium. If the problem stems from imbalance of other hormones, such as those in the thyroid, pituitary, or adrenal glands, the doctor will correct it with medication.

There are several other diseases that could be at fault. Both underactivity of the thyroid (hypothyroidism) and advanced liver disease can cause heavy bleeding. Women with leukemia (cancer of the white blood cells) and certain other blood disorders may also develop the problem.

Some medications can promote heavy bleeding. Among the offending drugs are steroids, digitalis (Digitoxin, Digoxin), and blood thinners. Withdrawal of estrogen or progesterone medication can also be a cause.

A woman who menstruates normally loses little iron during her period, but if you bleed heavily, you may develop anemia (iron deficiency). In that case, the doctor will usually stop the bleeding with hormones and advise you to take an oral iron preparation.