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Heavy periods (menorrhagia)

Heavy periods are when you have heavy bleeding during your period for several months in a row. Having heavy periods is also called menorrhagia.

The amount of blood lost during a period varies from one woman to another. On average, during your period, you will probably lose between 30 and 40ml of blood (two to three tablespoons). However, if your periods are heavy you may be losing much more than this.

Doctors class heavy periods as those where you’re losing between 60ml and 80ml of blood or more each period. However, it’s very difficult to measure this and isn’t diagnosed this way. Defining heavy periods is more to do with how much they interfere with your emotional and physical health in your daily life.

In the UK, around one in three women are affected by heavy periods.

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Details

  • Symptoms Symptoms of heavy periods

    It can be difficult for you to tell how much blood you’re losing each month, and it often looks much more than it is. So, the following signs can also show that you have heavy periods.

    • You need to change your sanitary towel frequently.
    • You need to use double sanitary protection, such as tampons and towels.
    • You pass large blood clots – these can be painful as they pass through your cervix.
    • You bleed through to your clothes or bedding (sometimes called ‘flooding’).

    If your periods are affecting your normal activities such as going out, working or shopping, this may also mean that they are heavy.

    These signs may indicate that your heavy periods are caused by something else. If you have any of these signs, see your GP for advice.

    You should also see your GP if you have other symptoms such as:

    • bleeding at other times apart from your period
    • pain or bleeding during or following sex
    • pain in your lower abdomen (tummy)
  • Diagnosis Diagnosis of heavy periods

    Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

    You may have some tests; the main ones are listed below.

    • Blood tests to check the levels of haemoglobin in your blood, along with iron levels and other hormones such as your thyroid function.
    • An internal examination. Your GP may place an instrument called a speculum inside your vagina to look at your vagina and cervix. He or she may also perform a ‘bimanual examination’. This involves inserting gloved fingers into the vagina and pressing on your lower abdomen at the same time with the other hand. This is to check for tenderness and changes to your uterus.
    • An ultrasound. An ultrasound uses sound waves to produce an image of the inside of the body.

    Your GP may refer you to a gynaecologist (a doctor who specialises in women’s reproductive health) for further tests.

  • Treatment Treatment of heavy periods

    Treatment of heavy periods may depend on what is causing them. If a cause can’t be found, your GP will suggest treatments to ease your symptoms. Which treatment you have will also depend on other factors such as your age, whether you’re planning to have children and whether you have other health problems.

    Medicines

    If your heavy periods are being caused by a specific condition, such as an infection, your GP will offer you treatment for that condition. Otherwise, medicines can be used to reduce the amount of bleeding and ease your symptoms. The main ones are listed below.

    • Intrauterine system (IUS). This is a small plastic device, put into your uterus, which slowly releases a hormone called levonorgestrel. The hormone reduces the lining of your womb making it thinner, which means you should bleed less. It’s also called the Mirena coil and gives you contraception as well as treating heavy periods.
    • Tranexamic acid. This can reduce the amount of bleeding.
    • Non-steroidal anti-inflammatory drugs (NSAIDs), such as mefanamic acid. These can reduce the amount of bleeding and ease pain.
    • The combined contraceptive pill. This can also help to reduce painful periods and make your periods more regular.
    • Progestogen. This may be suggested if other treatments haven’t worked. You can take this as a tablet or have an injection. The injection acts as a contraceptive too.

    If you have anaemia, your GP may also recommend that you take iron tablets.

    Always ask your GP or pharmacist for advice and read the patient information leaflet that comes with your medicine.

    Non-surgical treatments

    Uterine artery embolisation

    This may be suggested if your heavy periods are caused by fibroids. A thin tube is put into an artery in your groin and then moved until it reaches the blood vessels that supply the fibroids. A chemical is injected which blocks the blood vessels, causing the fibroids to shrink.

    Surgical treatment

    Myomectomy

    This is an operation to remove your fibroids. Your doctor may suggest this if you wish to have children and therefore don’t want to have your uterus removed.

    Endometrial ablation

    This is a surgical treatment where most of your womb lining is destroyed or removed using energy such as microwaves or heat. If you have fibroids or if you want to have children in the future then this type of treatment isn’t suitable.

    Hysterectomy

    Hysterectomy is an operation to remove your womb. It’s a major operation and is usually only done if all other treatments haven’t worked. After a hysterectomy, you will no longer have periods and won’t be able to become pregnant. It’s important that you’re fully informed about the implications of the surgery, speak to your doctor for more information and to talk through any questions you may have.

  • Treatment for heavy periods on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including heavy period treatment.

  • Causes Causes of heavy periods

    The exact reasons why some women have heavy periods aren’t fully understood at present. In four to six out of 10 women who have heavy periods, the cause is unknown.

    However, there are some conditions that can make heavy periods more likely, such as:

    Some women have heavy periods during the start of the menopause. The menopause is when your ovaries stop producing eggs. The age this happens is different for everyone, but it’s usually between 40 and 58. For more information, see our menopause topic.

    If you’re taking anticoagulant medicines, such as warfarin, or have an intrauterine contraceptive device (IUD or coil) fitted, then these can both cause heavy periods. Speak to your GP for more information.

  • Complications Complications of heavy periods

    Heavy periods can cause iron deficiency anaemia. Anaemia is a condition where you have too few red blood cells or not enough haemoglobin in your blood, which means your red blood cells and blood carry less oxygen. This causes symptoms such as tiredness, pale skin and feeling out of breath. Around two in three women with heavy periods have iron-deficiency anaemia.

    Menorrhagia can be distressing and can make you feel self-conscious and embarrassed during your period. It may also cause mood swings and affect your sex life.

  • FAQs FAQs

    Are there any side-effects from the medicines for heavy periods?

    Answer

    Yes, medicines for heavy periods can cause some side-effects.

    Explanation

    Side-effects are the unwanted effects of taking a medicine. If you have side-effects, it's important to talk to your GP, or the healthcare professional who prescribed your medicine, before you stop taking it.

    If you have an intrauterine system (IUS) (Mirena) fitted, you may notice that the pattern and length of your periods changes. Initially your periods may be irregular or prolonged. This usually settles in to light bleeding or no bleeding a few months after the IUS is put in. You may also have other side-effects such as tender breasts, back and lower abdominal pain and depression.

    If you’re taking tranexamic acid, you may feel sick, be sick or have diarrhoea. Non-steroidal anti-inflammatory drugs (NSAIDs) can make you feel sick, or be sick and can cause indigestion and heartburn. These medicines can also make asthma worse in people who already have the condition. If you’re taking the combined oral contraceptive pill, you may feel or be sick and have mood or weight changes.

    Speak to your GP for more information about the side-effects of any medicines you’re taking for heavy periods.

    Is it more difficult to get pregnant if you have heavy periods?

    Answer

    No, heavy periods (also known as menorrhagia) alone won’t usually make it more difficult for you to get pregnant. However, some causes of heavy bleeding may affect your fertility.

    Explanation

    Heavy periods alone won’t usually affect your ability to get pregnant. However, some conditions that cause heavy periods can make it more difficult. For example, fibroids can affect your fertility and make it more difficult for you to get pregnant. Pelvic inflammatory disease can also cause infertility.

    Tell your GP if you're trying to get pregnant, or want to have children in the future, as this will affect your treatment choices.

    When is surgery for heavy periods recommended?

    Answer

    This will depend on your own individual circumstances, including what is causing your heavy periods.

    Explanation

    Your treatment will vary depending on whether a cause can be found for your heavy periods, and if so, what this is. Your GP will usually first recommend medicines and non-surgical treatments to ease your symptoms, reduce the heavy bleeding and prevent anaemia from developing.

    Your GP will discuss your treatment options with you. There are a number of factors to consider when making a decision, including:

    • how well other treatments are working
    • the potential benefits and possible harms of the different treatments
    • whether you need contraception or not
    • how any treatment could affect your fertility if you want to have children

    Surgery is usually only recommended if other treatments for menorrhagia haven’t worked. The type of surgery you have will depend on your symptoms, what condition you have and whether you wish to keep your uterus.

  • Resources Resources

    Further information

    Sources

    • Menorrhagia. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published August 2012
    • Menorrhagia. Patient Plus. www.patient.co.uk, published March 2013
    • Simon C, Everitt H, van Dorp F. Oxford Handbook of General Practice. 3rd ed. Oxford: Oxford University Press, 2010: 706
    • Iron deficiency anemia. The Merck Manuals. www.merckmanuals.com, published May 2013
    • Treatment and care for women with heavy periods. National Institute for Health and Care Excellence (NICE), January 2007. www.nice.org.uk
    • Collins S, Arulkumaran S, Hayes K, et al. Oxford Handbook of Obstetrics and Gynaecology. 2nd ed. Oxford: Oxford University Press, 2008: 603
    • Heavy menstrual bleeding. National Institute for Health and Care Excellence (NICE), September 2013. www.nice.org.uk
    • Uterine artery embolization for fibroids. National Institute for Health and Care Excellence (NICE), November 2010. www.nice.org.uk
    • Fibroids. Patient Plus. www.patient.co.uk, published January 2012
    • Uterine fibroids. The Merck Manuals. www.merckmanuals.com, published June 2013
    • Pelvic inflammatory disease. Patient Plus. www.patient.co.uk, published November 2011
    • Joint Formulary Committee. British National Formulary (online) London: BMJ group and Pharmaceutical Press. www.medicinescomplete.com, accessed 17 October 2013 (online version)
    • Menorrhagia. BMJ Best Practice. www.bestpractice.bmj.com, published 18 January 2012
    • Menopause and its management. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed 21 October 2013
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    Reviewed by Natalie Heaton, Bupa Health Information Team, January 2014.


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