It can be hard to tell whether uterine bleeding is excessive. Generally, healthcare professionals consider things like bleeding that soaks through more than one tampon or pad every hour or lasts for more than a week as excessive.

Some people may have this once or every so often. Others may have more of a chronic issue that’s happening more regularly.

Such bleeding may be simply due to heavy menstruation. But in some cases, it may be a symptom of other conditions like growths or disorders.

Everyone has different levels of uterine bleeding. But changing a pad or tampon every hour, particularly if this occurs for more than 2 hours, is considered heavy bleeding.

You may also notice blood clots. If these are the same size as a quarter or any bigger, you may be experiencing excessive bleeding, too.

If you feel that the bleeding prevents you from living as you normally would, that’s also a sign.

The bleeding could be a sudden change, known as acute abnormal uterine bleeding. Or it could be an issue that’s been ongoing for months, known as a chronic issue.

Anything that involves the following alongside heavy bleeding is considered a medical emergency, so get medical care right away by calling 911 or local emergency services:

  • shortness of breath
  • feeling dizzy
  • chest pain

According to the Centers for Disease Control and Prevention (CDC), around one in five people with periods experience heavy bleeding. So, it’s definitely not uncommon. But there can be a variety of causes.

People who are new to having periods or are going through perimenopause can have lots of bleeding if they’re not ovulating for numerous menstrual cycles. This is because the tissue that lines the uterus can become thicker.

This can also affect people who have conditions like hypothyroidism or polycystic ovary syndrome (PCOS).

Not every form of excessive uterine bleeding is related to menstruation.

For example, noncancerous growths such as fibroids and polyps can cause heavy bleeding. Cancerous growths in the uterus or cervix can do the same.

Endometriosis, in which endometrial-like tissue grows outside of the uterus, or adenomyosis, in which similar tissue grows into the wall of the uterus, can also lead to excessive uterine bleeding.

Even medication can play a role, including hormonal birth control, aspirin, and blood thinning medication.

Other potential causes include:

  • bleeding disorders in which the blood doesn’t clot as it should
  • pregnancy-related difficulties such as pregnancy loss or an ectopic pregnancy
  • pelvic inflammatory disease

In some cases, more than one issue may lead to heavy bleeding.

A healthcare professional will usually ask about your lifestyle and medical history and perform a physical exam to find what’s causing the excessive bleeding.

It’s helpful to turn up to your appointment with notes on when bleeding is happening, how much blood you think you’re losing, and how long it lasts.

Some exams that may be carried out include:

  • a standard pelvic exam
  • blood tests to check for infections and other conditions
  • a Pap test to look at cells from your cervix
  • ultrasound, CT scan, or MRI scan to get a clearer picture of the internal organs

In some cases, an endometrial biopsy may be taken so your healthcare team can examine it more thoroughly and see if any cells look abnormal. This is more likely in people ages 45 and over.

In others, you may be given a hysteroscopy, in which a thin scope is inserted into the cervix, or a sonohysterogram, in which fluid is put inside the uterus through a similar thin tube during an ultrasound scan.

All of these tests are to help your clinician better understand the inside of your body and rule out potential causes of the bleeding.

The treatment depends on what’s causing or contributing to your bleeding and your ideal lifestyle.

For example, some people no longer want to have periods or become pregnant. Other people may want to have children in the future, which will rule out certain options.

If the bleeding is linked to your period or conditions like fibroids or PCOS, a healthcare professional may recommend a form of hormonal birth control to manage and reduce the symptoms.

For some people, the bleeding may stop completely with these methods. Others may only notice a reduction.

Any symptoms that may be linked to perimenopause or menopause can benefit from hormone therapy.

Gonadotropin-releasing hormone agonists can temporarily reduce the size of fibroids, while tranexamic acid is used for a short time to reduce bleeding. Blood clotting medications are used if a bleeding disorder has been diagnosed.

If medications don’t work, then there are surgical options to consider.

Endometrial ablation will destroy the lining of the uterus to either stop or reduce bleeding. This procedure will make it unlikely that you can get pregnant.

Research has found that this procedure controls bleeding more effectively than medications in the short term. But within 5 years, there’s no difference between the two.

A hysterectomy removes the uterus completely, meaning you’ll no longer menstruate or be able to become pregnant.

It’s often considered for fibroids, endometriosis, or adenomyosis when other treatments have failed. It’s used to treat endometrial cancer, too.

The following procedures can remove fibroids or limit their growth:

Fibroids can return after some surgeries, so these may not be a permanent solution.

It’s not uncommon to experience excessive uterine bleeding. But that doesn’t mean it’s not treatable or that help isn’t available.

If you’re finding your bleeding hard to manage or you’re worried that it’s a symptom of something else, book an appointment with a healthcare professional to discuss the options.

Lauren Sharkey is a U.K.-based journalist and author specializing in women’s issues. When she isn’t trying to discover a way to banish migraine episodes, she can be found uncovering the answers to your lurking health questions. She has also written a book profiling young female activists across the globe and is currently building a community of such resisters. Catch her on Twitter.