Heavy periods (menorrhagia)
Heavy periods (menorrhagia) is when you have more bleeding than normal, that lasts for a longer time. They can cause problems in your daily life. They are not usually a sign of anything serious.
Causes of heavy periods
Heavy periods are very common, especially when you have just started getting periods or are close to menopause.
In most cases there is no cause for the heavy bleeding. Occasionally, there is a cause, which can include:
- fibroids inside your uterus
- endometrial polyps
- endometriosis
- your intrauterine contraceptive device (IUD or IUS)
- hormonal problems such as polycystic ovary syndrome
- infections of the uterus or pelvic inflammatory disease
- cancer of the lining of the uterus
- medications, including those used to thin your blood such as warfarin
- some blood clotting disorders.
Symptoms of heavy periods
The amount of blood that is lost during your period varies a lot from person to person. If your periods are heavy, you may:
- have to change pads, tampons, menstrual cups or period underwear many times a day
- get up at night to change your tampon or pad, menstrual cup or underwear
- need to wear 2 pads or a pad and a tampon at the same time
- pass large clots during your period
- have bleeding that soaks through your clothes or bedding (this is called flooding).
The loss of blood might make you feel very tired. This could mean you have low iron in your blood, which can cause anaemia.
Diagnosing heavy periods
It is important to see your healthcare provider if you have heavy periods and any of the following:
- you are aged over 35
- you have suddenly started getting heavy periods
- you have pelvic pain
- you have bleeding after sex
- you have bleeding between periods
- sex is painful
- your periods are irregular.
It can be helpful to complete a period (menstrual) diary, which is a record of your periods. The diary can help your healthcare provider to understand how heavy your periods are and when you have period pain. You can also download a period tracker app.
Period (menstrual cycle) tracking apps — Healthify
Tests for heavy periods
You may need several kinds of tests to find the cause of your heavy periods, which may include:
- Blood test. To check for anaemia or blood clotting and to test your thyroid function or hormone levels.
- Ultrasound scan. To check for fibroids, ovarian cysts or abnormal thickening of your uterus lining.
- Pipelle biopsy. A procedure that takes a small sample (biopsy) of the cells from the lining of your uterus. If your general practice team does not do this procedure, they will refer you to another general practice that does.
- Hysteroscopy. A procedure where a small camera is passed through your vagina and cervix to look inside your uterus.
Treating heavy periods
Heavy periods can be managed in several ways. The right treatment for you will depend on things such as:
- your age
- your symptoms
- the cause of your heavy periods
- your general health
- whether you are planning to have a baby.
Your healthcare provider will first confirm there is no serious cause for your heavy periods. They may then discuss some ways to control the bleeding.
Non-hormonal treatments
- Tranexamic acid, which is a tablet that reduces bleeding by slowing the breakdown of clots in your uterus.
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen and mefenamic acid, which can reduce how much you bleed as well as treating pain.
- Iron tablets if you have anaemia. These do not treat the heavy bleeding, but they treat the low iron that the heavy bleeding causes.
Hormonal treatments
- The combined oral contraceptives pill.
- Progestogen-only contraceptives. These include tablets such as Cerazette and injectable progestogens such as Depo-Provera. They also include contraceptive implants. These usually reduce bleeding and can stop periods completely.
- Progesterone tablets including Provera (medroxyprogesterone). These are taken short term to reduce bleeding.
- Hormonal intra-uterine device (IUD). This is a small plastic device, placed in your uterus, which slowly releases the hormone progestogen. This causes the lining of the uterus to become thinner so there is less bleeding with each period.
Surgical treatments
Your healthcare provider will only consider surgery to treat your heavy periods if the treatments above have not worked. You should only have surgical treatment if you do not plan to get pregnant in the future.
Surgical options include:
- endometrial ablation —surgical removal of your uterus lining so you get little or no bleeding during your periods
- removal of you uterus (hysterectomy).