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Heavy periods (menorrhagia)

Key points

  • Heavy periods are when you have heavy bleeding during your period, for at least several months in a row.
  • Heavy periods can have a big impact on your day to day life and activities, and can lead to anaemia.
  • Treatment may include medicines, an intrauterine system (IUS) or sometimes surgery.
     

About heavy periods

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.

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)

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:

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 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.

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 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.

Reviewed by Natalie Heaton, Bupa Health Information Team, January 2014.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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