Why Is My Period So Heavy on the Second Day? Let’s Find Out!

Last updated 03.21.2024 | by Sabrina Johnson | 8 Minutes Read

This article has been reviewed and fact checked by Dr. Karen Pike, a senior physician administrator and board-certified emergency room doctor actively working in northern California. Read more at our medical disclaimer page.


More than a third of women report having heavy periods, and for most of us, the blood flow tends to be at its peak on the second day of our cycle.

Heavy periods, also known as menorrhagia, are a common phenomenon, but in some cases, it can be a cause for concern. So, it’s important to know how to spot the signs of unusually heavy menstrual bleeding and identify the cause.

Many women notice that menorrhagia gets worse during perimenopause. This was certainly the case for me.

For most of my adult life, my menstrual flow had been relatively light. However, once I entered perimenopause, I was suddenly experiencing heavy and prolonged periods, and the second day of my cycle was usually the worst of all. I’d have to change my tampon or pad every hour, and painful cramps made it difficult to get through the day.

The problem was so severe that the heavy bleeding was beginning to cause anemia. Iron deficiency anemia occurs when your body loses too many red blood cells and is unable to replace them quickly enough. I felt exhausted and weak, my skin was turning pale, and I developed frequent headaches.

Thankfully, a blood test spotted the problem before it got worse. And after my doctor prescribed supplements and I added natural sources of iron to my diet, I was soon feeling much better. My periods were still heavy, especially on the second day, but my anemia was under control. 

A couple of years later, menopause finally arrived, and now, my periods are a thing of the past. But I want to make sure other women understand the causes and risks of heavy menstrual bleeding so that they can take control of their bodies and avoid a situation like the one I found myself in.

So, is your period heavier than it used to be? Do you notice that your flow is heaviest on the second day? In this post, I’ll explain the potential reasons this can happen during perimenopause or at any stage of life.

Why Is My Period So Heavy on the Second Day?

Most women find that day two of their period is the heaviest. No matter whether your flow is heavy or light, the second day of your cycle tends to be the peak. This was always the case for me, and when my periods became heavier during perimenopause, the day-two flow was harder to manage than ever before.

But why does this happen? Like all menstrual symptoms, the answer can be explained by our hormones. During the second day of your cycle, your progesterone levels are at an all-time low. This triggers the release of chemicals called prostaglandins. These hormone-like chemicals cause the uterus to contract and shed its lining (otherwise known as endometrial tissue.) When prostaglandin production peaks -typically around day 2- it can lead to heavy bleeding and menstrual cramping.

What Are the Symptoms of Heavy Periods?

Most women only lose around 35 ml of blood during their period. However, women with heavy periods can lose more than 80 ml each month. While it’s not easy to accurately measure your own blood loss during your period, there are certain signs to look out for that can indicate your periods are heavier than usual. These include:

  • Needing to change your pad or tampon at least once an hour
  • Needing to wear a tampon and a pad, or two pads, to control blood flow
  • Getting up halfway through the night to change your tampon or pad
  • A period that lasts longer than 1 week
  • Noticing you pass blood clots, particularly frequent clots that are larger than a quarter (1 inch) in diameter

What are the Causes of Heavy Periods?

Most cases of menorrhagia have no obvious cause. It seems that some women are simply more prone to heavy periods. However, sometimes, there’s an underlying reason for a heavy flow, including:

Perimenopause

As we enter perimenopause, our hormones, particularly estrogen and progesterone, begin to shift. As this hormonal balance alters, all kinds of symptoms can occur, and the first to arrive is usually changes in the menstrual cycle.

Disrupted hormones can make your periods more irregular, and it can also increase the likelihood of heavy menstrual bleeding.

Intrauterine Devices (IUDs)

IUDs are a form of birth control that can cause heavy bleeding during menstruation in some women. This type of bleeding is most common with the use of copper IUDs and less so with hormonal versions. Usually, these symptoms will settle down around 6 months after implantation.

Uterine Fibroids

Uterine fibroids are a common condition characterized by noncancerous growths. It’s thought that around 70% of women develop fibroids at some point in their life. However, most of us don’t experience any symptoms. Those who do notice increased pain and heavier periods.

Uterine Polyps

Like fibroids, uterine polyps are small benign growths that form on part of the lining of your uterus. It’s a condition that causes heavy period bleeding, spotting between periods, bleeding after menopause, and potential infertility.

Endometriosis

Endometriosis is an increasingly common condition that causes endometrial-type tissue growth on the outside of the uterus. It can affect any area of the pelvic region, including the bladder and bowel, and it can lower your chances of getting pregnant. The most common symptoms include abnormally heavy period flow, a period that lasts 7 days or more, and severe period cramps.

Adenomyosis

Adenomyosis is similar to endometriosis. However, this condition causes an excess of endometrial-type tissue inside the uterine muscle rather than outside. The symptoms are similar, too. Women with adenomyosis may notice heavy blood flow during their period, painful periods, and a period that lasts 7 days or more.

Pelvic Inflammatory Disease

Pelvic inflammatory disease is an infection of the pelvis which, if left untreated, can cause irregular, heavy, and painful periods. Other symptoms include lower abdominal pain, fever, vaginal discharge, burning with urination, and pain and bleeding during sex.

Polycystic Ovary Syndrome (PCOS)

PCOS is a hormone-driven syndrome that affects more reproductive-aged women than any other endocrine condition. Women with PCOS typically have multiple cysts on the surface of their ovaries. These cysts can cause heavy bleeding during your period, changes in ovulation patterns, irregular periods, and spotting throughout your cycle.

Ectopic Pregnancy

A heavy period that comes on suddenly can be a sign of an ectopic pregnancy. This is a serious condition where the fertilized egg attaches itself outside of the uterus. If left untreated, it can cause life-threatening complications.

Medications

Certain forms of birth control and medications such as warfarin and other blood thinners can alter the balance of the reproductive hormones estrogen and progesterone. This can lead to changes in the menstrual cycle, including heavier periods.

When to Talk to Your Doctor?

Most of the time, heavy periods do not indicate a serious condition. However, it’s important to see a doctor if you are concerned.

Heavy periods and bleeding disorders can, in some cases, lead to anemia. If you experience symptoms such as tiredness, lightheadedness, weakness, pale skin, and breathlessness, book an appointment right away. Your doctor may want to order blood tests to check your iron levels and rule out any other potential underlying conditions.

FAQs

How can I reduce bleeding during my period?

Treatment options for a heavy menstrual period will depend on the underlying cause of your symptoms. Certain birth control pills can help to reduce the build-up of the uterine lining, leading to lighter periods. Medications such as tranexamic acid can also be used to treat heavy periods.

Can heavy periods indicate a bleeding disorder?

In rare cases, yes. Some women with a chronically heavy menstrual flow have a bleeding disorder, such as Von Willebrand disease. However, this is a relatively rare condition and is unlikely to be the reason for your heavy periods.

How do I know my period is normal, and when should I seek medical advice?

If you need to change your tampon or pad more than once every hour, several hours in a row, this could be a sign that you should see your doctor. They will ask you questions about your medical history, conduct any necessary examinations and testing, and help you identify what may be causing your heavy periods.

Conclusion

Many women experience heavy periods, particularly on the second day of their cycle. And in most cases, there’s no serious underlying cause. However, heavy periods can interfere with your usual activities, and over time, it may lead to complications such as anemia.

So, if you suffer from heavy periods, talk with your doctor. They will help you identify any causes and treatments necessary.

Author

  • Sabrina Johnson

    Meet Sabrina Johnson, a compassionate author and a seasoned expert in Obstetrics and Gynecology. She is a driving force behind Simply Menopause, where her extensive medical knowledge and empathetic nature come together to empower women in their menopausal journey. Sabrina offers culturally sensitive guidance and support through her approachable writing, making her a trusted friend on the path to menopause wellness.