Hormones and menopause | 5 min read
Heavy Periods and Fatigue: When to Check for Anemia
Editorial draft — clinical review pending.
Short answer: Heavy periods are one of the most common causes of iron deficiency and anemia in women, and anemia is a common cause of exhaustion. If your periods are heavier than usual and you feel unusually tired, weak or breathless, mention both together. A clinician can check for anemia and look for the cause of the bleeding. [1,2]
Key takeaways
- Bleeding is considered heavy if it lasts more than 7 days, needs a new pad or tampon in under 2 hours, or involves large clots. [2]
- Heavy bleeding has many causes, including perimenopause, fibroids, polyps, bleeding disorders and some medicines. [1]
- Iron supplements can treat low iron, but they don't fix the cause of the bleeding.
Is my period heavy?
You may have heavy menstrual bleeding if you: [2]
- Soak through one or more pads or tampons every hour for several hours in a row.
- Need to change products in less than 2 hours.
- Need to change during the night or double up on protection.
- Pass large clots.
- Bleed for more than 7 days.
- Plan your life around your period or miss work or activities because of it.
Common causes in your 40s
Perimenopause. Cycles without ovulation can cause the uterine lining to build up and shed heavily.
Fibroids and polyps. These noncancerous growths are common in midlife and can cause heavy or prolonged bleeding.
Adenomyosis. Tissue from the uterine lining grows into the muscle wall.
Bleeding disorders, such as von Willebrand disease, are more common than many people realize.
Medicines, including blood thinners, can increase bleeding.
Less commonly, changes in the uterine lining that need investigation, especially with bleeding between periods. [1]
Don't assume heavy bleeding is just perimenopause. A new or changing pattern deserves a check.
Signs of anemia
- Fatigue that doesn't improve with rest.
- Shortness of breath with activities that used to be easy.
- Feeling dizzy or lightheaded.
- Pale skin, headaches or cold hands and feet.
- Fast heartbeat.
- Restless legs or craving ice.
A simple blood test can check hemoglobin and iron stores (ferritin).
What to tell your clinician
- How many days you bleed and how often you change products on the heaviest days.
- Whether you have clots, bleeding between periods or after sex.
- How tiredness affects stairs, work and exercise.
- Any medicines and supplements you take.
You don't need to measure blood loss exactly. Practical details are enough.
Treatment options
Treatment depends on the cause and whether you want to preserve fertility. Options include a hormonal IUD, hormonal birth control, tranexamic acid, anti-inflammatory medicines during periods, and procedures for fibroids or polyps. Iron is often given at the same time to rebuild stores. [1]
When to get urgent help
Call 911 or go to an emergency department if bleeding is very heavy and you feel faint, have chest pain, a racing heart or trouble breathing.
Frequently asked questions
Can heavy periods cause anemia?
Yes. Heavy menstrual bleeding is a common cause of iron-deficiency anemia. [2]
Should I just take iron?
Talk to a clinician first. Iron can treat low iron, but the cause of the bleeding still needs to be found.
Are heavy periods normal in perimenopause?
They're common, but not something you have to live with, and other causes should be ruled out.
Next step
Bring both symptoms to one HerScripts conversation and get a plan that looks at the cause and the effects. Learn about changing periods.
Sources
[1] ACOG, Heavy Menstrual Bleeding
[2] CDC, About Heavy Menstrual Bleeding
Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.