Heavy Menstrual Flow: When a Tampon Saturates in Under an Hour

Saturating a regular tampon in <1 hour (or <2 hours for super) indicates heavy menstrual bleeding (HMB) – >80 mL/cycle.

Causes

• Structural: fibroids (submucosal), polyps, adenomyosis.
• Hormonal: anovulation, PCOS, thyroid, perimenopause.
• Coagulopathy: von Willebrand (most common inherited), platelet dysfunction.
• Iatrogenic: copper IUD, anticoagulants.
• Malignancy: endometrial hyperplasia/cancer (rare <40).

Evaluation

• CBC, ferritin, TSH, coagulation screen (if indicated).
• Pelvic ultrasound (first-line imaging).
• Endometrial biopsy if >45 or risk factors.

Management

• Tranexamic acid (antifibrinolytic) – reduces flow 30–50%.
• NSAIDs – reduce prostaglandins.
• Hormonal: combined OCs, LNG-IUD (first-line long-term).
• Surgical: hysteroscopic myomectomy/polypectomy, endometrial ablation, hysterectomy.

See clinician if saturating products hourly, passing large clots, or anemic symptoms.