Have you ever wondered how many times a day you change your pad or menstrual cup? A heavy menstrual flow affects 40% of women in the world and is called Abnormal Uterine Bleeding¹. The interval between one period and the next ranges from 24 to 38 days and lasts from 2 to 7 days, with a loss of 5 to 80 mL of blood. Therefore, variations in any of these parameters constitute abnormal uterine bleeding (AUB)².
The indications to define increased bleeding is for the woman to compare her flow with herself. More general questions can be asked, such as whether she can wait 3 hours to change the pad, how many pads she uses during her period (it shouldn't exceed 20), whether she has to get up at night to change the pad and whether she eliminates clots larger than 1 cm³.
During heavy and sudden uterine bleeding, there may be a risk of anemia, low blood pressure, shock and even death if there is no rapid intervention.⁴.
Treatment with hormonal contraceptives also shows good results for this condition, with some products even being recommended in the package leaflet for reducing abnormal uterine bleeding, for example, multiphasic regimens - which seek to mimic a woman's natural cycle - and some specific IUDs⁵’⁶.
In order to investigate the presence of heavy menstrual bleeding, 12 doctors specializing in abnormal uterine bleeding from around the world (HELP* group) got together and came up with questions that give indicative signs of the condition:
- Do you need to change your tampon during the night or wake up during the night to change the protection?
- During the heaviest days, have you ever had bleeding that spilled out of a tampon or pad in less than 2 hours?
- Do you expel large blood clots during your period?
- Have you ever felt short of breath during your period?
- Do you have to organize your social activities around your menstrual bleeding?
- Are you worried about having accidents related to your bleeding?
Adapted from: Silva Filho et al. Abnormal uterine bleeding: proposed approach of the Heavy Menstrual Bleeding Group. Femina, 43(4), 161-166, 2015⁷
If you answered “YES” to any of the above questions or suspect that your quality of life is being affected by excessive uterine bleeding, contact your gynecologist, as only he or she will be able to assess your case and advise you on the best treatment.
In the third episode of Biolab Cast, journalist Daiana Garbin welcomes Dr. Edson Ferreira and influencer May Diniz for an open conversation about the menstrual cycle - a natural process that still generates many doubts and taboos.
References
1 - BRAZILIAN FEDERATION OF GYNECOLOGY AND OBSTETRICS ASSOCIATIONS.
FEBRASGO Protocol No. 42: Abnormal uterine bleeding. São Paulo: FEBRASGO, 2018. Available at:
https://www.febrasgo.org.br/images/pec/Protocolos-assistenciais/Protocolos-assistenciais-ginecologia.pdf/Sangramento-uterino-anormal.pdf.
2 - Mikes BA, Vadakekut ES, Sparzak PB. Abnormal Uterine Bleeding. [Updated 2025 Feb 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532913/
3 - PORTAL OF GOOD PRACTICES IN WOMEN'S, CHILDREN'S AND ADOLESCENTS' HEALTH (IFF/Fiocruz). Main questions about abnormal vaginal bleeding. Rio de Janeiro: Fiocruz, 2019. Available at: https://portaldeboaspraticas.iff.fiocruz.br/atencao-mulher/principais-questoes-sobre-sangramento-vaginal-anormal/. Accessed on: Sep. 1, 2025
4 - BRAZILIAN FEDERATION OF GYNECOLOGY AND OBSTETRICS ASSOCIATIONS (FEBRASGO). FEBRASGO Position Statement: Abnormal uterine bleeding and chronic iron deficiency. Number 11 - December 2022. Available at: https://www.febrasgo.org.br/images/pec/posicionamentos-febrasgo/FPS-N11-Dezembro-2022-portugues.pdf. Accessed on: September 1, 2025.
5 - Fraser, |. S., et al. “Effective treatment of heavy and/or prolonged menstrual bleeding with an oral contraceptive containing estradiol valerate and dienogest: a randomized, double-blind Phase III trial.” Human reproduction 26.10 (2011): 2698-2708.
6 - Santos, A. L. dos, Lima, L. P., Bergamo, S. G., Rabelo, F. A., & Silveira, K. P. G. (2024). USE OF LEVONORGESTREL INTRAUTERINE DEVICES IN THE MANAGEMENT OF ABNORMAL UTERINE BLEEDING . Revista Ibero-Americana De Humanidades, Ciências E Educação, 10(11), 3929-3939. https://doi.org/10.51891/rease.v10i11.16812
7 - Silva Filho AL, Rocha ALL, Ferreira MCF, Celani M, Lamaita R, Cândido EB, Carneiro MM. Abnormal uterine bleeding: proposed approach of the Heavy Menstrual Bleeding: Evidence-Based Learning for Best Practice (HELP) Group. Femina, v. 43, n. 4, p. 161-166, jul.-aug. 2015. Available at: https://www.febrasgo.org.br/media/k2/attachments/FEM_v43n4.pdf
*HELP is a group of 12 independent doctors supported by Bayer. They are: Agnaldo Lopes da Silva Filho (Brazil), Alessandro Gambera (Italy), Benjamin Rösing (Germany), Jelena Andrejeva (Russia), Joaquin Calaf (Spain), Juan Acuna (Colombia), Marc-Yvon Arsenault (Canada), Qinjie Tian (China), Sarah Gray (United Kingdom), Silvia Ciarmatori (Argentina), SiHyun Cho (South Korea), Suresh Kumarasamy (Malaysia).
PP-QLA-BR-0299-1
September 2025