Heavy Menstruation as a Symptom of Adenomyosis

Many individuals experience a sensation of “leaking” during their menstrual periods. Some may not realize that heavy menstrual bleeding can be a symptom of conditions like adenomyosis and endometriosis. In this discussion, we will explore the link between heavy menstrual bleeding and adenomyosis, as well as provide guidance on managing it if you frequently experience heavy bleeding.

When Does a Menstrual Period Qualify as Heavy?

Individuals typically lose approximately 60 milliliters of blood during their menstrual period, roughly equivalent to one and a half shot glasses. Usually, it takes about four hours for a regular-sized tampon or sanitary pad to reach total capacity and require changing. However, it is essential to note that bleeding can be more substantial during the initial days of your period compared to the later days. Therefore, there is usually no cause for concern if you need to change your tampon or pad more frequently for a short period. It is also not unusual for menstrual bleeding to be heavier than usual [1].

Medical professionals diagnose heavy menstruation, known as hypermenorrhea when more than 80 milliliters of blood are consistently lost during each menstrual cycle. This may manifest as the need to change a regular-sized tampon or pad every one to two hours, resulting in more than five tampons or pads per day. The presence of thick blood clots during menstruation can also indicate heavy bleeding, a common adenomyosis symptom.

If you experience weakness, fatigue, and listlessness in addition to heavy bleeding, it is essential to seek medical evaluation. Keeping a record of the number of pads or tampons used over two menstrual cycles can inform your attending gynecologist regarding the amount of blood flow [1].

Why Heavy Menstruation is Often a Symptom of Adenomyosis

The underlying cause of increased menstrual bleeding is frequently associated with the impaired contraction of the uterus. This insufficient contraction results in inadequate loosening of the uterine mucous membrane, making it challenging for blood to exit the uterus [1]. Inflammation and adhesions, which can develop due to conditions like adenomyosis and endometriosis, are often responsible for this dysfunction.

In adenomyosis, the typical lining of the endometrium infiltrates and grows within the muscular layer of the uterus. This process leads to a thickening of the uterine wall and an overall enlargement of the uterus.

Other Factors Contributing to Heavy Menstrual Bleeding

Adenomyosis is closely associated with endometriosis, where tissue similar to the endometrium settles and grows outside the uterine cavity. It is common for women to experience both conditions simultaneously, and heavy menstrual can be a common symptom. However, it is essential to recognize that adenomyosis can also manifest independently of endometriosis, and conversely, endometriosis is frequently found in combination with adenomyosis [2].

Nevertheless, it is crucial to acknowledge that heavy menstrual bleeding can have other underlying causes besides adenomyosis and endometriosis, including:

  • Hormonal fluctuations, such as those during breastfeeding or menopause.
  • Thyroid gland disorders.
  • Benign tumors called myomas that can develop in the uterus.
  • The formation of benign growths known as polyps in the uterus.
  • Bleeding disorders, such as hemophilia.
  • The use of specific medications.
  • In rare instances, uterine cancer.

Regardless of the potential cause, seeking medical evaluation is advisable if you are experiencing heavy menstrual bleeding. If your gynecologist has ruled out other reasons but is not well-versed in adenomyosis and endometriosis, consider consulting a specialist or a certified endometriosis center for further assessment and guidance.


Heavy menstrual bleeding may indicate adenomyosis. On the other hand, adenomyosis cannot be ruled out if there is no heavy menstrual bleeding. This is because in about 30 percent of cases, adenomyosis progresses without symptoms. [3]

What Are the Potential Consequences of Heavy Menstruation?

Whether heavy menstrual bleeding is a symptom of adenomyosis, endometriosis, or another underlying cause, it can significantly impact daily life.

Sometimes, individuals may be compelled to limit their activities or cancel appointments, mainly when concerned about having enough opportunities to change tampons or pads. Consequently, some people experience limited mobility during their periods and struggle to fulfill their personal and professional responsibilities fully. This can be exacerbated by feelings of listlessness and fatigue, mainly when disrupted sleep occurs due to frequent tampon or pad changes, further contributing to emotional distress. Individuals with irregular cycles may also worry about unexpected heavy bleeding in inconvenient situations, potentially affecting their confidence, including in intimate situations.

Furthermore, excessive bleeding can lead to a depletion of iron and other nutrients in the blood, a condition known as anemia. Anemia results in reduced concentration of red blood cells or red blood pigment in the blood, with symptoms such as fatigue, dizziness, decreased performance, and pale skin and mucous membranes. Healthcare providers can assess iron levels in the blood and prescribe iron tablets or drops when necessary. They may recommend iron infusions to replenish the body’s iron stores in severe cases.

What Are the Treatment Options for Heavy Menstrual Bleeding as a Symptom of Adenomyosis?

The management of heavy menstrual bleeding resulting from adenomyosis is generally similar to that for other underlying causes. From a medical perspective, intervention is typically recommended only if anemia develops due to significant blood loss. In other cases, the decision to pursue treatment with medication or surgical procedures should be based on an individual assessment of the impact of heavy menstrual bleeding and consideration of one’s fertility preferences, as most treatment options can have short- or long-term effects on fertility.

For instance, hormonal contraceptives such as birth control pills, hormone patches, or hormonal intrauterine devices (IUDs) can effectively reduce heavy menstrual bleeding by suppressing the growth of the uterine lining while also serving as contraception when used consistently. Additionally, specific pain relievers may help diminish the amount of blood flow.

In cases of severe symptoms when fertility is not a concern, options include removing or sclerosing (hardening) the uterine lining. This procedure is known as endometrial resection or endometrial ablation. In the most severe instances, surgical removal of the uterus (hysterectomy) may be considered a treatment option [1].

Heavy Menstruation as a Symptom of Adenomyosis: Self-Care Strategies

Eine orang-rote Menstruationsscheibe aus Silikon vor beigem Hintergrund.

A menstrual disc is flatter than a menstrual cup and has an even larger capacity.

If you experience heavy menstruation, taking it easy during your period is advisable. Relaxation exercises can be beneficial, or some individuals find solace in physical activity. If you feel more comfortable, consider working from home during your period and openly discussing this with your employer to break the taboo around period-related discomfort.

To feel more secure at night or when on the go, combine tampons with pads, and always keep extra sanitary products at your desk and in your bag in case of unexpected needs. Menstrual cups are worth trying as they hold more fluid than many disposable hygiene products. They come in various sizes, so choose one with an appropriate capacity. Alternatively, menstrual pads, which are flatter and broader than menstrual cups and resemble diaphragms, offer even more capacity. Menstrual cups and pads can be sustainable and cost-effective alternatives, especially if you have high tampon and pad consumption due to heavy menstrual bleeding.

If you have a heavy period, drink enough water and incorporate iron-rich foods like legumes, whole grains, and leafy green vegetables into your diet. Non-vegans can also include animal-based foods such as eggs and meat to prevent anemia. In the long term, consider dietary changes, including certain fatty acids, vitamins, and fiber, which may help alleviate symptoms related to adenomyosis or endometriosis. Explore numerous recipes on our blog and in our endometriosis app.


It is crucial to address heavy menstrual bleeding, although not every case requires treatment unless it leads to anemia, primarily characterized by symptoms like weakness and concentration problems. Collaborating with healthcare specialists is essential to determine whether your heavy menstrual bleeding is a symptom of adenomyosis, endometriosis, or another underlying cause. You may discover practical strategies for managing heavy bleeding independently, even without taking medication or surgery. Nevertheless, it is advisable to undergo regular iron level assessments to prevent anemia.


1. Federal Ministry of Health, in cooperation with the Institute for Economic Efficiency in Health Care (IQWiG). https://gesund.bund.de/starke-regelblutung#leben-und-alltag (retrieved on 15.04.2023)

2. Expert interview with Dr. med. Franz-Ferdinand Bitto from the MIC Center Munich on „One in Ten“. https://www.one-in-ten.de/interview-experte-dr-bitto/ (retrieved on 15.04.2023)

3. Hutmacher, J., Imesch P., Fink D. The adenomyosis. 2018. https://www.rosenfluh.ch/media/gynaekologie/2018/01/Die-Adenomyose.pdf (abgerufen am 15.04.2023)

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Friederike Grigoleit
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