A woman’s menstrual cycle is very personal and highly individual. What’s considered a “normal” period for one woman may be extremely abnormal for another. Some women seem to be blessed with light periods and little discomfort, while others struggle with naturally heavy bleeding and pain.

“Heavy bleeding, or menorrhagia, is common among women and one of the most common problems I hear about from my patients,” says board-certified obstetrician and gynecologist Stephanie Shisler, M.D., a gynecologist and physician on the medical staff at Texas Health Rockwall. “In fact, the Centers for Disease Control and Prevention reports that heavy bleeding affects more than 10 million women in the U.S. each year. This means that about one out of every five women experiences problematic periods.”

“What many women do not know is that many options are available to treat menorrhagia,” Shisler adds. “Additionally, some women do not seek help because they are too embarrassed to talk with a doctor about their problem. Speaking openly with your doctor is very important in making sure you are diagnosed properly to get the optimum treatment.”

So how does a woman determine what is a normal menstrual period and what isn’t? When is it time to discuss concerns with your gynecologist?

On average, menstrual bleeding lasts about 4 to 5 days and the amount of blood lost is small — between 2 and 3 tablespoons. However, women who have menorrhagia usually bleed for more than 7 days and lose twice as much blood. Shisler recommends using these guidelines in determining when a doctor’s visit is mostly likely in order:

• Have a menstrual flow that soaks through one or more pads or tampons every hour for several hours in a row
• Need to double up on protection to control your menstrual flow
• Need to change pads or tampons during the night
• Have menstrual periods lasting more than 7 days
• Have a heavy menstrual flow that keeps you from doing the things you would do normally
• Have constant pain in the lower part of the stomach during your periods
• Are tired, lack energy or are short of breath

Just as the menstrual cycle is unique to each individual, so too are the potential causes of heavy bleeding. A woman may experience menorrhagia due to a hormone imbalance, non-cancerous uterine fibroids or polyps, problems related to pregnancy (miscarriage or ectopic pregnancy) or cancer of the uterus or cervix. Pelvic inflammatory disease and other more minor infections can also cause increased menstrual bleeding.

“The type of treatment I recommend will depend on the cause of the excessive bleeding and how serious it is,” says Shisler. “To evaluate the problem, I will obtain a comprehensive medical history and perform a thorough physical. I may request a blood test, Pap test, endometrial biopsy or ultrasound. Factors such as age, general health, and a woman’s wants and needs are also considerations in determining a treatment plan. For example, some women want to make sure they can still have children in the future. Others want to lessen the pain more than they care to reduce the amount of bleeding and some women do not want to have a period at all. I always discuss all treatment options with a woman and, together, we can decide which is best for her.”

Shisler points out that a variety of treatment options exist for the various causes of heavy menstrual bleeding. Lifestyle modifications, including weight loss, can be helpful. Iron supplements may be prescribed to help ease anemia associated with heavy blood loss. Birth control pills and other hormonal options can help lighten and shorten menstrual flow as well as ease pain. And in more severe cases, surgical options such as hysterectomy and endometrial ablation to remove all or part of the endometrial lining of the uterus may be considered.

Left untreated, heavy or prolonged bleeding can stop you from living your life to the fullest. The good news is that it’s relatively easy to re-establish and maintain a healthy, regular cycle when you give your body the right support and seek the help of a qualified doctor.