Menstruation is a natural process that nearly all women and people with a uterus experience during their reproductive years. However, not all periods are created equal. Some are light and last only a few days, while others can be heavy, prolonged, and even debilitating. For many, a heavy period is just part of life. But what if your period is so heavy that it interferes with your daily activities, causes you to feel weak or fatigued, or leads to iron-deficiency anemia?
What Are Bleeding Disorders?
Bleeding disorders are a group of medical conditions that affect the way your blood clots. When you have a bleeding disorder, your body may take longer than normal to stop bleeding after an injury or surgery, or you may bleed spontaneously without an obvious cause. These conditions are usually caused by problems with clotting factors—proteins in the blood that help stop bleeding—or with platelets, the blood cells that form clots.
Some common bleeding disorders include:
- Von Willebrand disease (VWD): The most common inherited bleeding disorder, affecting up to 1% of the population.
- Hemophilia A and B: Rare but well-known bleeding disorders more common in men, though women can be carriers and may also have symptoms.
- Platelet function disorders: Conditions where the platelets don’t work properly, even if there are enough of them.
- Other clotting factor deficiencies: Rare deficiencies in other clotting proteins like factor VII, XI, or XIII.
These conditions can range from mild to severe. Some people don’t find out they have a bleeding disorder until they have surgery, dental work, or childbirth.
How Is Menstruation Affected by Bleeding Disorders?
While bleeding disorders can affect both men and women, they are particularly relevant to people who menstruate because menstruation involves regular blood loss. If the body has trouble clotting, periods can become significantly heavier or longer than normal. In fact, heavy menstrual bleeding is often the first and sometimes only symptom of a bleeding disorder in women and girls.
Signs Your Period Might Be Abnormally Heavy
It’s not always easy to know whether your period is “normal” or not, especially since menstrual experiences vary so much. But if your periods interfere with your quality of life, that’s a signal to take them seriously. Signs that your bleeding might be heavier than normal include:
- Soaking through one or more pads or tampons every hour for several hours in a row
- Needing to change protection during the night
- Doubling up on pads to prevent leaks
- Bleeding for more than seven days
- Passing large blood clots (larger than a quarter)
- Becoming anemic (iron deficiency) or fatigued from blood loss
- Missing work, school, or activities due to your period
If you experience several of these symptoms, it could indicate an underlying bleeding issue.
Von Willebrand Disease: The Most Common Culprit
Von Willebrand disease (VWD) is the most common inherited bleeding disorder and affects both men and women. However, it’s often underdiagnosed in women because symptoms can be mistaken for normal menstruation.
VWD occurs when there is a deficiency or dysfunction of von Willebrand factor (VWF), a protein that helps platelets stick together and adhere to blood vessel walls. Without enough VWF, it’s harder for the blood to clot properly.
Symptoms of VWD in People Who Menstruate:
- Heavy or prolonged periods
- Easy bruising
- Frequent nosebleeds
- Bleeding gums
- Excessive bleeding after surgery or dental work
- Heavy bleeding after childbirth
- Family history of bleeding problems
VWD can be mild and go unnoticed, or more severe and obvious. But in all cases, proper diagnosis and management can make a big difference.
Why Are Bleeding Disorders Often Missed?
Many women grow up thinking that heavy periods are just something they have to deal with. Society often normalizes women’s pain and discomfort, especially around menstruation. As a result, people may not seek medical help or may be told by doctors that their bleeding is “just part of being a woman.”
This leads to underdiagnosis. In fact, studies show that many women with bleeding disorders go undiagnosed for years—sometimes even decades. One study found that it can take an average of 16 years from the onset of symptoms to diagnosis for women with VWD.
Furthermore, most bleeding disorders are inherited, but not everyone in a family may show symptoms. Even if your relatives don’t have obvious bleeding problems, you could still be affected.
Getting Diagnosed: What to Expect
If you suspect your period might be a sign of a bleeding disorder, the first step is to talk to a doctor—ideally a gynecologist or hematologist familiar with these conditions.
Your doctor may ask questions like:
- How long do your periods last?
- How many pads or tampons do you use per day?
- Do you pass clots? How large?
- Do you have other signs of bleeding, like nosebleeds or bruising?
- Do you have a family history of bleeding problems?
You may be asked to fill out a menstrual bleeding questionnaire or keep a period diary.
Tests might include:
- Complete blood count (CBC): To check for anemia or low platelets.
- Iron levels: To assess for iron-deficiency anemia.
- Coagulation tests: Such as PT, aPTT, and platelet function analysis.
- Von Willebrand factor tests: To check VWF levels and function.
- Clotting factor assays: To test for other factor deficiencies.
These tests can often be done with a blood sample. Diagnosis can sometimes require repeat testing, as levels of clotting factors can vary with stress, illness, and hormones.
Treatment and Management Options
The good news is that bleeding disorders can be managed effectively, even if there’s no cure. The key is to work with your healthcare team to develop a treatment plan tailored to your symptoms and lifestyle.
Common treatment options include:
- Hormonal therapy: Birth control pills, hormonal IUDs, or other hormone treatments can help regulate or reduce menstrual bleeding.
- Desmopressin (DDAVP): A medication that stimulates the release of stored VWF in people with certain types of VWD.
- Tranexamic acid: An antifibrinolytic medication that helps prevent clot breakdown, reducing blood loss during menstruation.
- Iron supplements: To treat or prevent anemia caused by blood loss.
- Clotting factor replacement therapy: For more severe bleeding disorders, replacing the missing clotting factors may be necessary.
In some cases, lifestyle changes—like avoiding medications that thin the blood (e.g., aspirin, ibuprofen)—can also help.
Emotional and Practical Impact
Living with a bleeding disorder, especially when undiagnosed, can be frustrating and exhausting. You may feel isolated, anxious, or even embarrassed about your symptoms. But you’re not alone, and there’s nothing shameful about having a bleeding condition.
Many people find it empowering to get a diagnosis—it validates their experience and opens the door to better treatment. Connecting with support groups and advocacy organizations, such as the National Hemophilia Foundation or the Foundation for Women & Girls with Blood Disorders, can also provide education and community.
When to Talk to a Doctor
You should seek medical advice if:
- Your periods are so heavy they interfere with your life.
- You have symptoms of anemia (fatigue, dizziness, shortness of breath).
- You bruise easily or bleed for a long time after cuts.
- You have a family history of bleeding problems.
- You bled excessively after surgery, dental work, or childbirth.
Don’t wait until symptoms get worse—early diagnosis and treatment can greatly improve your quality of life.
Final Thoughts
A heavy period isn’t just a “woman’s burden” or a quirk of biology—it can be a medical red flag. If you’ve always thought your bleeding was worse than everyone else’s, you might be right. Bleeding disorders like von Willebrand disease are more common than you might think, and getting diagnosed can help you take control of your health.
You deserve to be heard, taken seriously, and treated with respect. If you suspect something’s wrong, trust your instincts and advocate for your health. Your period shouldn’t be a monthly crisis—and it doesn’t have to be.