Heavy Menstrual Bleeding
Also known as: Menorrhagia, Heavy periods
Heavy menstrual bleeding is menstrual blood loss that is heavy enough or prolonged enough to interfere with your physical, emotional, or social life. Practically, that can mean soaking through a pad or tampon every hour for several hours, needing to change protection overnight, passing large clots, or bleeding for more than seven days. It is one of the most common gynecological complaints and has many possible causes, from hormonal imbalance and fibroids to bleeding disorders. Over time it can lead to iron deficiency anemia, with tiredness and shortness of breath. Effective treatments exist, so heavy periods are not something you simply have to put up with.
At a Glance
- Common symptoms
- Soaking through one or more pads or tampons every hour for several consecutive hours, Needing to double up on protection or change it during the night, Bleeding lasting longer than seven days
- Main treatments
- Tranexamic acid taken during periods to reduce blood loss, Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce bleeding and cramping, Hormonal options such as the levonorgestrel IUD, combined pills, or progestogens
- Category
- Reproductive · Very common; one of the most frequent reasons for gynecological consultations
- See a doctor if
- Bleeding soaks a pad or tampon every hour for more than two hours
Symptoms
Causes
- Hormonal imbalance causing the uterine lining to build up excessively (common around puberty and perimenopause)
- Uterine fibroids or polyps
- Adenomyosis (uterine lining tissue growing into the muscle wall)
- Lack of ovulation, as in PCOS or thyroid disorders
- Bleeding disorders such as von Willebrand disease, or blood-thinning medication
- Copper intrauterine devices, pelvic infection, or, rarely, uterine or cervical cancer
Risk Factors
- Being in the years just after periods start or approaching menopause
- Fibroids, polyps, or endometriosis
- Obesity
- Family history of a bleeding disorder
- Use of anticoagulant medication
Diagnosis
- Detailed menstrual history, sometimes using a pictorial blood loss chart
- Blood tests for anemia, iron stores, thyroid function, and clotting if indicated
- Pelvic examination and pregnancy test
- Pelvic ultrasound to look for fibroids, polyps, or adenomyosis
- Endometrial biopsy or hysteroscopy if the lining needs closer assessment
Treatment
- Tranexamic acid taken during periods to reduce blood loss
- Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce bleeding and cramping
- Hormonal options such as the levonorgestrel IUD, combined pills, or progestogens
- Iron supplements to correct anemia
- Procedures such as removal of fibroids or polyps, endometrial ablation, or, in selected cases, hysterectomy
- Supportive: an iron-rich diet (red meat, legumes, leafy greens) with vitamin C to aid absorption
- Supportive: tracking cycles and flow so you and your doctor can judge whether treatment is working
Prevention
- Maintain a healthy weight, since excess body fat affects estrogen levels
- Treat underlying conditions like thyroid disorders promptly
- Keep iron intake adequate, especially if periods are on the heavy side
- Attend routine gynecological check-ups
- Discuss bleeding risk before starting anticoagulants or a copper IUD
When to See a Doctor
- Bleeding soaks a pad or tampon every hour for more than two hours
- Periods regularly last longer than seven days or come with large clots
- You feel dizzy, faint, unusually tired, or short of breath
- Bleeding between periods, after sex, or after menopause
- Heavy bleeding during pregnancy or with severe pelvic pain (seek urgent care)
Frequently Asked Questions
Related Conditions
Related Reading
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