Heavy Bleeding (Menorrhagia): When to Worry About the Clots

Topic: Menstrual health

How much blood is “too much”? In school, we generally aren’t taught quantify our flow. We just deal with it. But “flooding” holds many women back from work, sports, and life.

The Definition of Heavy

You have Menorrhagia if:

1. You soak through a “Super” pad/tampon in less than 2 hours.
2. You pass clots larger than a 2-rupee coin (or a quarter).
3. You have to use “double protection” (pad + tampon) to leave the house.
4. You wake up at night to change due to overflow.

The Causes (PALM-COEIN)

Doctors use this acronym:

• Polyp: A sterile growth inside the uterus.
• Adenomyosis: Endometriosis inside the muscle wall. (Bulky, boggy uterus).
• Leiomyoma (Fibroid): The most common structural cause.
• Malignancy: (Rare) Cancer.
• Coagulopathy: Bleeding disorders.
• Ovulatory Dysfunction: PCOS (building up lining for months -> massive crash).
• Endometrial: Thin lining issues.
• Iatrogenic: Copper IUD/Blood thinners.

The Impact: Anemia

Heavy bleeding causes Iron Deficiency. Iron Deficiency causes fatigue… and strangely, more bleeding. (Iron is needed to clot blood). It is a vicious cycle.

Treatments (Non-Hysterectomy)

You don’t always need “the big surgery.”

1. Mirena IUD: Reduces bleeding by 90% in most women.
2. Tranexamic Acid: A non-hormonal pill taken only during the period to clot blood.
3. Ablation: Burning off the lining (for women done with kids).

Don’t accept “just live with it.” Anemia is exhausting.