Heavy bleeding can occur at any age, but it is most common on either end of the reproductive age spectrum, during the teenage years and then again during perimenopause, when estrogen levels tend to be higher in relation to progesterone.
The causes of heavy periods and the related conditions to heavy periods fall into three categories:
A) Hormonal imbalances –
1. A period that is heavy, dark, clotted, clumpy, or looks like frozen crushed up blueberries, is indicative of higher estrogen levels. Estrogen is a proliferative hormone, responsible for stimulating the growth of the uterine lining and breast tissue. Breast tenderness, stubborn weight, acne, PMS, headaches or migraines can result from too much estrogen in relation to progesterone, which is known as estrogen dominance.
2. Another imbalance that may contribute to heavier flow is low thyroid function, or hypothyroid. Thyroid hormone and progesterone are intricately connected – if your body is not producing adequate thyroid hormone, your progesterone levels may drop as well, causing estrogen to become dominant over progesterone. And, hypothyroid also causes poor estrogen detoxification.
B) Uterine problems or conditions –
1. Endometriosis and Adenomyosis
2. Uterine fibroids – interestingly fibroids don’t actually cause heavier bleeding, but they are related to heavy bleeding because high estrogen/low progesterone causes both fibroids and heavy bleeding. Fortunately, the type of fibroids that cause heavy bleeding (submucus fibroids) only account for 5-10% of all submucus fibroids.
3. Polyps – these can cause abnormal bleeding, but it is not usually heavy.
4. Miscarriage, ectopic pregnancy or postpartum.
C) Other illnesses diseases or medications
1. Medications like the depo provera shot, as well as the Paragard (copper) IUD.
2. A bleeding disorder known as von Willebrand disease – known as a coagulopathy, this condition is associated with problems in how the blood clots. Twenty percent of adolescent girls with severe menorrhagia have a blood coagulation problem.
3. Liver, kidney and pelvic inflammatory disease.
Note: Endometrial cancer may cause irregular bleeding in the form of spotting, but it is not a cause of heavy bleeding.