What the ER will do for heavy menstrual bleeding

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A person should go to the ER if they:

• have bleeding that soaks through one pad or tampon per hour for several hours
• pass blood clots that are larger than a quarter
• have a rapid heart rate, low blood pressure, or both
• feel dizzy or confused
• have heavy bleeding that differs from their usual pattern, in addition to other symptoms
• could be pregnant, as the bleeding could be a miscarriage
• have heavy bleeding shortly after giving birth or having a miscarriage, as this could be a postpartum hemorrhage

If a person loses consciousness, someone should call 911 to get them emergency help.

The ER specializes in treating potentially life threatening emergencies. Symptoms that are not as severe as the ones listed above may not need emergency care. Instead, a person can seek medical attention from a doctor or gynecologist.

When a person visits the ER due to heavy menstrual bleeding, the first priority is to make sure they are stable. A doctor will test for:

• hypovolemia, which is when there is not enough fluid in the body
• hemodynamic instability, which is unstable blood pressure
• pregnancy, if this is a possibility

The ER doctor will also ask questions about the current episode of bleeding. Questions may relate to:

• when the bleeding started
• how much blood they have lost
• whether their periods are typically regular
• whether they bleed between periods
• whether they have passed blood clots
• whether they are in pain

Additionally, a doctor may ask about and look for signs of injury. This may require a physical examination, ultrasound scan, or both.

If the bleeding is not an emergency, a doctor may refer the person to another doctor for follow-up care.

Treatment for heavy bleeding first involves stabilizing the person and stopping the bleeding.

If a person is unstable, a doctor will give IV fluids. They may also recommend a blood transfusion.

What happens next will depend on whether a person is pregnant. If the pregnancy test is positive, doctors will begin treating for a potential miscarriage.

If the test is negative, they may administer additional treatments to stop the bleeding and reduce other symptoms. This could include:

• estrogen, which may help stop the bleeding
• tranexamic acid to increase blood clotting
• iron tablets to treat anemia
• pain medication such as ibuprofen (Advil) for cramping

There are also surgical procedures that can reduce or stop heavy menstrual bleeding, such as dilation and curettage (D and C), which removes the top layer of uterine tissue. Another option is tamponade with a Foley bulb, which involves inserting a device in the uterus to apply pressure, which can stop bleeding.

When a physical injury causes excessive bleeding, a person might need surgery. For example, a perforation due to an intrauterine device (IUD) may require surgery to remove the IUD and repair the perforation.

Bleeding during pregnancy

If tests show that a person is pregnant, their treatment may involve some of the same approaches as above, but they will have different aims.

For example, a miscarriage sometimes requires no treatment. However, in other cases, a doctor may perform a D and C to remove the remains of the pregnancy.

Another potential cause of bleeding during pregnancy is a subchorionic hemorrhage. This is a bleed near the membranes that protect the developing fetus. Larger bleeds may require admission to the hospital.

Learn more about subchorionic bleeding.

A person can leave the hospital once they are stable, the cause of the bleeding is known, and the immediate emergency has passed.

Depending on the cause, there may be a risk that the bleeding will start again. If this is a possibility, a doctor may prescribe additional medications to take home. They may recommend following up with another doctor for ongoing care.

Once home, it is important to rest, drink enough fluids, and take any medications as the doctor instructs.

Some causes of heavy vaginal bleeding require long-term treatment or management. For example, heavy bleeding could be due to:

• polycystic ovary syndrome
• growths in the uterus, such as uterine polyps or fibroids
• endometriosis
• adenomyosis
• blood clotting disorders

Each of these conditions has a different set of treatment options. Some examples include:

• hormone therapy
• hormonal IUDs
• medications to increase blood clotting
• operative hysteroscopy, which allows a doctor to see inside the uterus and remove growths
• endometrial ablation or resection, which removes part or all of the uterine lining
• hysterectomy, which removes the whole uterus

Endometrial ablation, endometrial resection, and hysterectomy result in a person being unable to get pregnant. A doctor might consider them if the bleeding does not respond to other treatments.

Doctors define heavy menstrual bleeding as blood that soaks through one pad or tampon once an hour for several hours in a row. If this is the case, or a person feels weak or dizzy, or becomes unconscious, dial 911 or go to the ER.

ER doctors can administer fluids to stabilize a person. They may also give a blood transfusion or medications or, potentially, perform a medical procedure to stop the bleeding. The exact treatment will depend on a person’s situation.

Some causes of heavy bleeding require follow-up care, so it is important to contact a doctor or gynecologist after leaving the hospital.