“Beyond the first year after my period started, I don’t think I ever had what you would call a normal flow,” says Rupkatha, 23, a student based in Kolkata. “My flow was heavy throughout my period. But one of my stand-out memories is from when I was 14, and I had been to a fancy restaurant for lunch. I changed my pad when I entered the place, yet somehow within an hour, I had bled through the pad and completely stained the restaurant’s cushioned chair. I changed my pad immediately afterwards, and it took me about fifteen minutes to come back home in a car, yet I had stained the car seat by that time. I had barely learnt what my period was like, so I didn’t realise when my pad overflowed. To experience that in a crowded public place was incredibly harrowing as a child.”

During the course of that period, Rupkatha had to go through twelve pads within twenty-four hours. Heavy periods or menorrhagia is a menstrual condition in which you experience extremely heavy blood flow that interferes with your physical, social or emotional quality of life. “Menorrhagia can affect you at any age, although it is more commonly seen in women above 30,” says Dr Anuradha Panda, obstetrician and gynaecologist at Apollo Hospitals, Hyderabad. One in every five menstruating people worldwide are affected by this, says the Centre for Disease Control and Prevention, USA.

According to Dr Panda, warning signs of heavy menstrual bleeding can be any of the follows:

• A prolonged flow for more than 7 days, or much longer than your usual period (for example, 7 days if you otherwise have a 3-day long period)
• Bleeding enough that you have to change your pad or tampon every hour or every other hour, or drain a half-full 30 ml menstrual cup for more than 6 times during your period
• Having to double up on pads
• Passing clots larger than 1 inch, or unusually large compared to your past periods
• Very heavy flow all of a sudden if you are above 40 years of age

“The heaviness I experienced was not just in terms of flow, but also how long it lasted,” recounts Rupkatha, whose period would sometimes last for as long as a month at a stretch. “It’s definitely not just inconvenient or an annoyance; it impaired my physical health greatly. If you are on your period for a month straight, it completely weakens you. I would feel exhausted all the time. Personally, I also get really hungry when I am on my period, so a month long period would mean a month of binge-eating, which just cannot be sustainable for your health.”

Tiredness or fatigue is an important sign to watch out for to judge whether your period is healthy, says Dr Panda. “Because of the heavy blood loss, a lot of people experience weakness and tiredness. They also lose a lot of iron, which causes iron deficiency anemia. This can make them experience dizziness, or they will feel short of breath or experience chest pains.” According to the doctor, most people get help only after these other symptoms show up.

 

What Causes Heavy Menstrual Bleeding?

When Rupkatha first went to consult a gynaecologist at the age of 16, he touted a shallow reassurance: it was a problem faced by every household, and she was too young to worry about it. “At that time, my family and I were kind of overjoyed,” she says, “because it felt good to know that this was common, and not meant to be a source of concern. But even if it was common, not getting the right treatment in time just did not help.”

The problems of heavy bleeding and its associated symptoms persisted, and could not be ignored. This made consult a second gynaecologist a year afterwards, who diagnosed her with the root of the problem: polycystic ovarian syndrome, or PCOS. PCOS is a condition characterised by hormonal imbalances, which causes irregular ovulation. This can result in the endometrium, or the lining of the uterus, to become thicker, which takes the form of abnormal uterine bleeding, including longer and heavier periods. In almost 50 percent of those who experience heavy bleeding, there is no obvious cause. Diagnosing what is causing your heavy period can be difficult, but usually, the following reasons could be behind it, according to Dr Panda:

• Uterine fibroids, which are abnormal growths that form in the muscle of the uterus
• Endometrial polyps, which are non-cancerous growths of the linings of the uterus
• Endometriosis, a disorder in which tissue that normally lines the uterus grows outside the uterus
• Problems with an intrauterine device (IUD), a form of birth control
• PCOS
• An ectopic pregnancy or a miscarraige
• Medications like chemotherapy
• In rare cases, thyroid disease or liver disease