Overview
Periods are called heavy when the bleeding is more than you can comfortably manage. Doctors call this menorrhagia, or heavy menstrual bleeding. There is no single amount that counts as heavy. What matters is the effect on your life.
Some women have heavy periods that are normal for them and need no treatment. For many others the bleeding disrupts work, study, sleep and exercise, and it can use up the body's iron. Heavy periods are common and can usually be treated.
Symptoms
You may have heavy periods if you:
- Need to change a pad or tampon every one to two hours
- Need two products at once, such as a pad and a tampon
- Pass clots larger than about 2.5 cm
- Bleed for more than 7 days
- Bleed through to your clothes or bedding
- Avoid exercise or take time off work because of your periods
Heavy bleeding can also bring tiredness and shortness of breath.
When to see a doctor
See a doctor if heavy periods affect your daily life, or come with severe pain, bleeding between periods or after sex, or pain when passing urine, opening the bowels or having sex. Also see a doctor for tiredness or breathlessness that does not go away, and for any bleeding after the menopause.
Causes
Heavy periods are common when periods first start, after a pregnancy and as the menopause approaches. A hormone imbalance, often when the ovaries do not release an egg, is the most common cause. Other causes include:
- Fibroids (non-cancerous growths in the womb) or polyps
- Endometriosis or adenomyosis
- Polycystic ovary syndrome (PCOS)
- Infection of the womb and tubes (pelvic inflammatory disease)
- Bleeding disorders, such as von Willebrand disease
- Some medicines, such as blood thinners, and some cancer treatments
- Rarely, cancer of the womb
Risk factors
- Being a teenager whose periods have just begun
- Approaching the menopause
- Being overweight
- Fibroids, endometriosis, PCOS or a bleeding disorder
Complications
- Iron deficiency anaemia, with tiredness and breathlessness
- Time lost from work and study
- A treatable cause, such as a fibroid or a hormone problem, going unnoticed
Prevention
There is no sure way to prevent heavy periods. What helps is not waiting:
- Keep a simple record of when your periods start and end and how many pads or tampons you use
- Ask for a blood test if you feel tired or breathless
- Get the cause found and treated
Diagnosis
The doctor will ask about your periods and examine you. Tests may include:
- Blood tests to look for anaemia, and sometimes for clotting problems and thyroid disease
- A pregnancy test
- A pelvic examination and a cervical test
- An scan of the womb and ovaries
- Sometimes a look inside the womb with a thin camera (hysteroscopy), or a small sample of the womb lining ()
Treatment
Heavy periods do not always need treatment, but treatment can help when they affect daily life. The choice depends on the cause, your age, whether you want to become pregnant and what you prefer.
- A hormone-releasing coil (intrauterine system) or the combined contraceptive pill
- Tranexamic acid tablets, which reduce bleeding
- Anti-inflammatory painkillers such as mefenamic acid or naproxen, which can ease both the pain and the bleeding
- Iron supplements, if blood tests show anaemia
- Treating the cause, for example removing a polyp or fibroid
- A procedure to remove or destroy the lining of the womb (endometrial ablation)
- Removing the womb (hysterectomy), which ends periods and the chance of pregnancy, when other treatments have not worked
Aspirin can make bleeding last longer, so avoid it for period pain if you have a bleeding problem.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Heavy periods are normal. Every woman has them, so there is nothing to be done.”What is true?
Fact
Some women have heavy periods that are normal for them, and these do not always need treatment. But when the bleeding gets in the way of daily life, treatment can help, and it is worth finding out whether something is causing it, such as fibroids, a hormone problem or a bleeding disorder.
Myth“Losing a lot of blood in the period is the body cleaning itself, so it does no harm.”What is true?
Fact
Heavy bleeding can use up the body's iron and lead to anaemia, which brings tiredness and breathlessness. A blood test can check for it, and treatment is available.
Myth“The only cure for heavy periods is to remove the womb.”What is true?
Fact
Removing the womb (hysterectomy) is one specialist option, but there are several others. They include a hormone-releasing coil or the contraceptive pill, tablets that reduce bleeding, anti-inflammatory painkillers, and procedures that treat the lining of the womb or remove fibroids.
Myth“Heavy periods are a sign of cancer.”What is true?
Fact
There are many causes, and cancer of the womb is a rare one. Bleeding between periods, after sex or after the menopause should always be checked, but heavy periods on their own are far more often due to hormones, fibroids and similar conditions.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How do I know if my periods are heavy enough to see a doctor?
If the bleeding gets in the way of your life, it is heavy enough. Signs include changing a pad or tampon every hour or two, passing large clots, bleeding through to clothes or bedding, and avoiding exercise or work because of your periods.
Why am I so tired during and after my period?
Heavy bleeding can use up the body's iron and cause anaemia, which makes you tired and short of breath. A simple blood test can check. Treating the heavy bleeding, and iron where it is needed, can help.
Will I need an operation?
Most treatments for heavy periods do not involve an operation. Medicines and a hormone-releasing coil help many women. Procedures and surgery are options for those who need them, and your doctor will go through the choices with you.
Are heavy periods normal when periods first start or near the menopause?
They can be, because hormones are changing. They still deserve a check if they affect your life or if you feel tired or breathless, since treatment is available.