Listen to your body

It's normal to see some variation when you start menstruating and again as you approach menopause. But if you notice changes in your period along the way, try to decipher what your body is trying to tell you.

Stress and other factors, including certain medications, can impact your cycle. But you shouldn't just have an increase in your flow or a consistently heavy flow. And that's true regardless of your age.

Menorrhagia is the medical term for unusually heavy or long menstrual periods. Many women have heavy flow days and cramps when they have their period. But menorrhagia is not common.

How do you recognize a heavy flow?

It's hard to define exactly what having heavy periods is because the flow varies from woman to woman. Heavy flow for one woman may be normal flow for another.

Most women will lose less than 16 teaspoons of blood (about 80ml) during their period, with the average being about 6-8 teaspoons.

Heavy menstrual bleeding is defined as loss of 80ml or more each period, periods lasting more than 7 days, or both.

A good indication that your period is heavy is if you:

• Must change your pad, tampon, panties every hour or 2
• Lose blood clots larger than 2.5cm (about the size of a 10p coin)
• If blood gets through your clothes or bedding
• Need to use 2 types of hygienic products at the same time (for example, tampons and pads)

Heavy periods can cause anemia and severe cramps.

Because measuring your total blood loss is impractical, the best way to find out if your period is unusually heavy is to talk to your doctor.

Here are some possible causes:

1. Polyps on the cervix or uterus

Heavy periods are sometimes a sign of uterine or cervical polyps. These small growths around the cervix are usually caused by high estrogen levels or infections and can be removed with minor surgery, so spotting between heavy periods can be another sign that you have polyps .

2. Endometriosis

A heavy period can also be a sign of endometriosis, which occurs when uterine tissue grows outside the uterus into the pelvic cavity. Other symptoms of endometriosis include severe menstrual cramps, pain during sex, lower back pain before or during your period, and difficulty having a bowel movement. Endometriosis is notoriously difficult to diagnose, but identifying it is important, especially if you are planning to have children, as it can lead to infertility.

3. Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is an infection of the reproductive organs that can lead to infertility if left untreated. Some signs that you may have PID are stomach or lower abdominal pain, nausea, vomiting, fever, or problems with intercourse or urination.

4.Uterine fibroid tumors

Up to 70-80% of women develop fibroids by the age of 50, and although these tumors are usually not cancerous, they are still worth investigating

6. A bleeding disorder

Heavy menstrual bleeding could be a sign of immune thrombocytopenia (ITP), which prevents blood from clotting properly. If you suffer from this disease, you may also experience easy bruising and nosebleeds. Heavy periods could also indicate the bleeding disorder von Willebrand's disease, which results in abnormal platelets that prevent blood from clotting, especially if the heavy period started when you were under 18. According to the American Congress of Obstetricians and Gynecologists, von Willebrand disease is the most common inherited bleeding disorder in American women and is seen in 5-24% of women with chronic heavy periods. Blood tests can usually identify these disorders.

7. Irregular ovulation (often caused by PCOS)

Various hormonal imbalances can cause women to ovulate irregularly, and ovulation releases progesterone, which prevents the lining of the uterus from forming. If a woman is not ovulating, there is nothing to control this buildup. Then, when ovulation occurs (but not pregnancy), the accumulated lining comes out all at once during menstruation. One possible cause of these imbalances is polycystic ovary syndrome (PCOS), which affects 5 to 10 percent of women of childbearing age. If your period is both heavy and irregular and you also have abnormal body hair or a high BMI, you may need to see an endocrinologist to get tested for PCOS. Lack of ovulation could also be a symptom of thyroid disease or hyperprolactinemia, which can also be identified by an endocrinologist.

If you're going through your box of tampons at an unusually fast rate or your heavy menstrual panty isn't enough and you've noticed other symptoms, it may be time to make an appointment go to your gynecologist and figure out what's going on. Whatever the source, all blood loss resulting from heavy periods can lead to anemia, so even if there is nothing serious behind this heavy flow, it is better to treat it for your health and peace of mind.