Heavy flow or clots
Soaking protection, passing larger clots, or changing often?
Explore careFolsom, California
Heavy & Irregular
Bleeding Care
Heavy periods? Bleeding between periods?
Understand what may be causing your bleeding. Explore medications, hormonal IUDs, in-office hysteroscopy, Cerene, and surgery when appropriate.
Assess if Your Period Is Too Heavy?Optional: expand to review the scoring guide and track up to 10 days.Expand assessment
Optional tool
Bleeding pattern tracker
Record flow, clots, and flooding across up to 10 days. The score is an estimate to discuss—not a diagnosis or treatment decision.
Pictorial bleeding assessment
Scoring guide
Match each day’s products and clots to the examples below. Flooding is noted separately and adds no points.
Pads
1 pointLight stain
5 pointsModerate
20 pointsSaturated
Tampons
1 pointLight
5 pointsModerate
10 pointsSaturated
Clots & flooding
1 pointSmall · grape
5 pointsLarge · strawberry
Flooding / gushingNote the day; no points added.
Research reference: 100+ points per period. This adapted tracker is not a diagnosis. Read the study reference and limitations.
PBAC score0research reference: 100+
Start entering data below.
A higher score may be worth discussing with a clinician.
Day 1
Pad · light1 point each
0
Pad · moderate5 points each
0
Pad · saturated20 points each
0
Tampon · light1 point each
0
Tampon · moderate5 points each
0
Tampon · saturated10 points each
0
Clot · small1 point each
0
Clot · large5 points each
0
| Flow or clot | Day 1 | Day 2 | Day 3 | Day 4 | Day 5 | Day 6 | Day 7 | Day 8 | Day 9 | Day 10 | Count | Score |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pads | ||||||||||||
| Light stain (1 pt) | 0 | 0 | ||||||||||
| Moderate (5 pts) | 0 | 0 | ||||||||||
| Saturated (20 pts) | 0 | 0 | ||||||||||
| Tampons | ||||||||||||
| Light stain (1 pt) | 0 | 0 | ||||||||||
| Moderate (5 pts) | 0 | 0 | ||||||||||
| Saturated (10 pts) | 0 | 0 | ||||||||||
| Clots | ||||||||||||
| Small — grape size (1 pt) | 0 | 0 | ||||||||||
| Large — strawberry size (5 pts) | 0 | 0 | ||||||||||
| Flooding / gushing Note only, no points | 0 days | — | ||||||||||
| Total PBAC score | 0 | |||||||||||
Flooding noted on 0 day(s). Discuss this with your provider regardless of the total score.
PBAC score0research reference: 100+Consider discussing your chart
Below 100Research reference: 100+
0100150+
Start entering data above to see your score interpretation.
Limitations: This chart estimates a pattern, not a cause. Lower scores do not rule out conditions such as fibroids or polyps. It is not validated for menstrual cups or discs.
Changes worth discussing
What has changed about your bleeding?
Different patterns can have different causes. Choose the closest match to see what may be discussed at an evaluation.
Periods lasting longer
Bleeding that continues longer than your usual pattern.
Explore careBleeding between periods
Spotting or bleeding outside your expected period.
Explore careUnpredictable periods
Cycles that have become irregular or hard to anticipate.
Explore carePain or pelvic pressure
Cramping, pain, or pressure alongside bleeding changes.
Explore careBleeding despite treatment
Symptoms continue or return while using a treatment.
Explore careYou do not need to know the cause before reaching out. Your symptoms and goals help guide the next step.
Educational overview
Understanding Heavy Menstrual Bleeding
Learn about common causes, evaluation, and treatment options. A change in bleeding can have more than one explanation.
What counts as heavy or irregular bleeding?
Signs to discuss include soaking a pad or tampon every hour for several hours, periods lasting more than seven days, passing clots the size of a quarter or larger, needing extra protection, or waking to change it. Bleeding between periods or after sex also deserves evaluation. The effect on your life matters—not just the amount of blood.
Fibroids and polyps
Fibroids are growths in or around the uterine muscle; polyps grow from the uterine lining. Their size and location can affect bleeding, pressure, and which treatments may help.
Explore fibroid care →Ovulation and hormonal changes
Irregular ovulation, including with PCOS or during perimenopause, can change how the uterine lining builds and sheds. Thyroid conditions and other health changes can also affect bleeding. Testing depends on your history.
Learn about PCOS →Adenomyosis and painful periods
Adenomyosis occurs when tissue similar to the uterine lining is found in the uterine muscle and may cause heavy, painful periods. Endometriosis is a different condition that can cause pelvic pain. Your symptoms and imaging help guide evaluation.
Explore endometriosis care →Medicines, bleeding disorders, and other causes
Blood thinners, some contraceptives, and bleeding disorders can affect flow. Easy bruising, nosebleeds, or heavy bleeding since your first periods are useful to mention. Pregnancy-related bleeding and changes in the uterine lining, including precancer or cancer, may also need to be considered. Do not stop prescribed medicines without advice.
Bleeding that continues despite treatment
Let your clinician know if bleeding persists, returns, or changes while using treatment. Review when it began, missed doses, side effects, and any new symptoms. Further testing or a different approach may be appropriate; do not assume that ongoing bleeding is simply something to tolerate.
Evaluation before treatment
How Haven evaluates your bleeding
Your symptoms, history, and pregnancy plans guide which steps are useful. Not everyone needs every test.
01History & examinationDiscuss your pattern, health history, medicines, and goals.
02Blood work when appropriateMay check for anemia, pregnancy, or other causes.
03Ultrasound & imagingLook at the uterus and identify findings that may need follow-up.
04Uterine cavity evaluationSome people may need hysteroscopy or a lining sample.
Your history and examination
Discuss the timing, duration, and amount of bleeding, pain, fatigue, and its impact on daily life. Bring your medicine and supplement list, relevant records, prior treatments, and pregnancy or contraception goals. An examination may help identify whether bleeding comes from the uterus, cervix, or another source.
Which tests might be recommended?
Not everyone needs every test. Depending on your situation, evaluation may include a pregnancy test, a blood count for anemia, iron studies, selected hormone or thyroid tests, and testing for a bleeding disorder. Ultrasound can help assess the uterus and ovaries.
Learn about pelvic ultrasound →Heavy bleeding and iron deficiency
Repeated blood loss can lower iron levels and cause anemia. Mention fatigue, weakness, breathlessness, dizziness, or a racing heartbeat. Evaluation may include blood tests and a plan to address both iron deficiency and the cause of bleeding. Severe symptoms need urgent care.
Looking at the uterine lining or cavity
A saline-infusion ultrasound, hysteroscopy, or endometrial biopsy may be recommended depending on bleeding patterns, age, risk factors, and other findings. Sampling can assess changes in the lining; hysteroscopy allows a direct view of the cavity. Your clinician will explain why a test is suggested and discuss comfort options.
Explore hysteroscopy →In-office hysteroscopy at Haven
A thin camera helps your clinician view the uterine cavity and may guide evaluation or treatment of polyps and selected fibroids.
Why it may be recommended
Bleeding patterns and imaging findings help determine whether looking inside the uterus or treating a growth could be useful.
Comfort and preparation
Your care team will explain preparation, pain-control choices, alternatives, and what the planned procedure involves before you decide.
What to expect afterward
Recovery depends on the procedure performed. Your clinician will explain follow-up and warning signs such as fever, severe pain, or heavy bleeding.
In-office treatment discussion
Cerene: an option for heavy periods
Whether Cerene is an option for you depends on an evaluation and an informed discussion of benefits, risks, and alternatives.
Could Cerene fit my goals?
Cerene's patient information describes use for premenopausal patients with heavy menstrual bleeding from benign causes who have completed childbearing. It is not for someone who is pregnant or plans a future pregnancy.
Preparation and comfort
Ask which tests are needed, what treatment involves, available pain-control choices, and which alternatives could meet your goals.
Recovery, benefits, and risks
Results and recovery vary. Risks can include pain, infection, bleeding, or injury. Ablation is not contraception; pregnancy afterward can be dangerous. Your clinician should discuss contraception, warning signs, follow-up, and the full safety information.
Watch one patient's Cerene experience
One patient's experience; outcomes and recovery vary.
What to Expect at Your Bleeding Appointment
Tell us what’s changed
Share your bleeding patterns, symptoms, medicines, and goals.
Understand what needs evaluation
Discuss which tests may be useful and why they are recommended.
Compare options and build a plan
Review your results, treatment choices, and follow-up together.
Bring cycle dates, your medicine list, prior results, and questions. Tracking is optional.
Request an AppointmentQuestions before you book?
Practical answers about bleeding, testing, and your options.
When should I seek urgent care for heavy bleeding?
Seek urgent medical attention for heavy bleeding with dizziness, fainting, chest pain, shortness of breath, or severe pain. Soaking a pad or tampon every hour for more than two hours, especially with these symptoms, is a warning sign. For severe symptoms, call 911. Do not wait to finish tracking your bleeding.
Do I need to track my bleeding before requesting care?
No. Tracking is optional. If useful, note cycle dates, bleeding between periods, protection changes, clots, pain, and medicines. The PBAC chart estimates a bleeding pattern for discussion; it does not diagnose a cause or determine treatment eligibility.
Can heavy periods cause anemia?
Yes. Ongoing blood loss can lead to iron deficiency and anemia. Mention fatigue, dizziness, weakness, breathlessness, or a racing heartbeat. Your clinician may recommend blood tests and treatment for both iron deficiency and the underlying bleeding.
Does unusual bleeding mean cancer?
Many causes are benign, including fibroids, polyps, and ovulation changes. Bleeding alone cannot tell you the cause. Age, symptoms, risk factors, and examination findings guide whether imaging or a uterine-lining sample is needed. Any bleeding after menopause deserves prompt evaluation.
Can a hormonal IUD help?
A levonorgestrel-releasing IUD can reduce heavy bleeding for many patients and provides contraception. It differs from a copper IUD, which may increase bleeding. Medicines and other treatments are also options; suitability depends on your evaluation, preferences, and health history.
How do hysteroscopy and Cerene differ—and what if I want a future pregnancy?
Hysteroscopy uses a small camera to examine the uterine cavity and may allow removal of a polyp or selected fibroid. Cerene treats the uterine lining with cryotherapy to reduce heavy bleeding in eligible premenopausal patients with benign causes who have completed childbearing. Ablation is not appropriate if you want a future pregnancy and is not contraception; pregnancy afterward can be dangerous. Discuss alternatives that fit your reproductive goals.
What if treatment does not help?
Contact your care team if bleeding continues, returns, or changes. Your clinician can review the diagnosis, medicines, side effects, and any new symptoms, and decide whether further testing or another treatment is appropriate. Do not delay urgent care for severe bleeding or symptoms.
Find a plan for your bleeding.
Bring your concerns and goals. We’ll help you understand your options.
Clinical lead: Dr. Nikita Mishra, MD, FACOG. Educational information supports—not replaces—individual care.
Sources and further reading
- ACOG: Heavy Menstrual Bleeding
- ACOG: Abnormal Uterine Bleeding
- Higham JM, O’Brien PMS, Shaw RW. Assessment of menstrual blood loss using a pictorial chart. British Journal of Obstetrics and Gynaecology. 1990;97:734–739.
- Cerene: Manufacturer safety information