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Heavy periods (menorrhagia)

Expert reviewer, Dr Madhavi Vellayan, Consultant Gynaecologist
Next review due May 2024

You have heavy periods if the bleeding is regularly interfering with your daily life. The medical name for heavy periods is menorrhagia.

Heavy periods are common and are more likely to develop as you get older. They are most common in women aged between 30 and 49. But only around five in every 100 women will see their GP about this.

An image showing the female reproductive system

About heavy periods

The amount of blood lost during a period varies from person to person. On average, you’ll lose between 30 and 40ml of blood (two to three tablespoons). But if your periods are heavy, you lose much more than this.

Periods are heavy when you lose 80ml of blood or more each period or when you bleed for more than seven days. It’s difficult to measure the amount of blood you lose during a period. A good indicator that you have heavy periods is if you’re changing your tampon or sanitary towel every hour or two or passing blood clots.

Some people have heavy periods all the time. Others have them at certain times in their lives such as during puberty or just before the menopause.

The most important thing used to diagnose heavy periods is the impact they have on you. If they’re affecting your quality of life, your doctor may suggest treatment.

Symptoms of heavy periods (menorrhagia)

The main symptom of heavy periods is losing 80ml of blood or more each period. It can be difficult to tell how much blood you’re losing each month. Here are some signs to look out for that could show that your periods are heavy.

  • You need to use more than nine pads or tampons on your heaviest days.
  • You use a tampon and a towel at the same time or you use two towels to prevent leaks.
  • You pass blood clots bigger than 2.5cms (about the size of a two pence piece) – these can sometimes be painful.
  • You bleed through to your clothes or bedding – this is called flooding.

Heavy bleeding is also likely to affect your usual activities. It can interfere with your work and social life, your relationships and leisure time.

If you have any of the above symptoms, contact your GP.

You may also have other symptoms such as pain or discomfort alongside heavy bleeding. These can sometimes be a sign that your heavy periods are caused by an underlying condition. If you have any of the following, always contact your GP.

  • Bleeding between periods or after you have sex.
  • Pain after you’ve had sex or before your period or pain that doesn’t go away.
  • A feeling of pressure in the lower part of your tummy (abdomen).

Diagnosis of heavy periods

Your GP will ask about your symptoms and medical history, and how the heavy bleeding affects you. They may also examine your abdomen or do an internal examination to look at your cervix if you also have other symptoms. These might include pressure in your tummy, bleeding after having sex or bleeding between periods.

Your GP may also ask to do a ‘bimanual examination’. This involves putting fingers into your vagina (they’ll wear gloves) while pressing on your tummy at the same time with the other hand. This is to check for tenderness and changes to your womb.

You might need to have some tests. The main ones are listed below.

  • A blood test to check for anaemia and to see how well your blood clots.
  • A pregnancy test to check if your bleeding is a complication of being pregnant.
  • An ultrasound scan, which produces images of the inside of your abdomen and your womb (uterus).
  • Hysteroscopy, which is a procedure to look inside your womb. Your doctor may also take a sample of your womb lining. This is called an endometrial biopsy.

Treatment of heavy periods

The main aim of treatment for heavy periods is to improve your symptoms and quality of life. If there’s a particular condition causing the heavy bleeding, then treatment for that may ease the symptoms. There are several treatments. Talk to your doctor about the pros and cons of each, and what might be the best option for you.

The treatment you have will depend on things like your age and general health and if you’re planning to have children. Your GP will be able to prescribe some treatments, but you may also be referred to see a specialist.

Intrauterine system (IUS)

This is a small, plastic device that’s put into your womb. It slowly releases a hormone called levonorgestrel, which is a progesterone hormone. This hormone reduces the lining of your womb making it thinner, which means you should bleed less.

The device works as a contraceptive as well as a treatment for heavy periods. It usually stays in place for three to five years, depending on the type of device you have.

Medicines

Medicines can reduce the amount of bleeding you have and ease your symptoms. The main ones used to treat heavy periods are:

  • tranexamic acid
  • non-steroidal anti-inflammatory drugs (NSAIDs) such as mefenamic acid
  • the combined or progesterone-only contraceptive pill

If you have anaemia, you might need to take iron tablets.

Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or GP for advice.

Uterine artery embolisation

This is a possible treatment choice if your heavy periods are caused by fibroids. Your doctor will put a thin tube into an artery in your groin and then move it until it reaches the blood vessels that supply the fibroids. They will inject a chemical that blocks the blood vessels and shrinks the fibroids.

Surgery

Surgery is usually suggested if other treatments haven’t worked. There are three main types of surgery that can be used to treat heavy periods.

  • Endometrial ablation is an operation to destroy or remove most of your womb lining. If you want to have children in the future, this treatment is unlikely to be an option.
  • Myomectomy is an operation to remove fibroids without removing your womb. Your doctor may suggest this if you want to have children in the future. There are other procedures to treat fibroids.
  • Hysterectomy is an operation to remove your womb and it’s the only complete cure for heavy periods. But it’s a major operation, so usually it would only be an option if all other treatments haven’t worked. After a hysterectomy, you won’t have periods and you won’t be able to have children.
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Causes of heavy periods

For about half of women who have heavy periods there is no specific cause. But some conditions can make heavy periods more likely. These include:

  • fibroids or polyps (growths of tissue) in your womb
  • polycystic ovary syndrome (PCOS)
  • adenomyosis – this is when cells that normally line your womb grow into the muscle wall as well
  • endometriosis – this is when cells that normally line your womb grow in other parts of your body
  • an infection, such as pelvic inflammatory disease (PID)
  • other health conditions – for example, an underactive thyroid, liver disease, kidney disease
  • copper-containing intrauterine contraceptive devices (IUD or coil)

Complications of heavy periods

Heavy periods can cause iron-deficiency anaemia. This is when you have too few red blood cells, which means your blood carries less oxygen than you need. This can make you feel tired, out of breath and give you a headache. Around six in 10 women with heavy periods have iron-deficiency anaemia.

Heavy periods can be distressing and have a major impact on your daily life. You may find that you’re less likely to play sport, exercise or go out when you have your period. Understandably, the impact of such heavy periods can affect your mood and mental health, so it’s important to talk about these things with your GP.

Frequently asked questions

  • Some of the causes of heavy bleeding can make it more difficult for you to get pregnant. Conditions such as fibroids and pelvic inflammatory disease can affect your ability to get pregnant.

    Tell your doctor if you're trying to get pregnant or want to have children in the future. This will affect your treatment choices.

  • Yes, the medicines and devices used to treat heavy periods can cause some side-effects. Side-effects are the unwanted effects of using a medical device or taking a medicine.

    If you have an intrauterine system (IUS) fitted, you might notice that the pattern and length of your periods change. In the first six months after it’s put in, you might have lighter, heavier or less regular periods.

    This usually settles into light bleeding or no bleeding within a year after you have the IUS put in. You may also have other side-effects such as tender breasts, headaches, and acne.



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Related information

    • Menorrhagia. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised December 2018
    • Heavy menstrual bleeding: assessment and management. National Institute for health and Care Excellence (NICE). www.nice.org.uk, last updated May 2021
    • Heavy periods. Patient information from BMJ. BMJ Best Practice. bestpractice.bmj.com, published January 2021
    • Menorrhagia. Patient – Professional Reference. patient.info/plus, last edited May 2020
    • Heavy periods. Women’s Health Concern. womens-health-concern.org, reviewed November 2019
    • Personal communication, Dr Madhavi Vellayan, Consultant Gynaecologist, May 2021
    • Gynaecology. Oxford Handbook of General Practice. Oxford Medicine Online. oxfordmedicine.com, published online June 2020
    • Pelvic examination technique. Medscape. emedicine.medscape.com, updated September 2018
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    • Endometrial sampling. Patient – Professional Reference. patient.info/plus, last edited October 2015
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    • Intrauterine System. Patient – Professional Reference. patient.info/plus, last reviewed 24 August 2020
    • Uterine artery embolisation for fibroids. National Institute for Health and Care Excellence (NICE), November 2010. nice.org.uk
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    • Uterine fibroids. BMJ best Practice. bestpractice.bmj.com, last updated December 2020
    • Fergusson RJ, Bofill Rodriguez M, Lethaby A, et al. Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding. Cochrane Database of Systematic Reviews 2019; 8. doi: 10.1002/14651858.CD000329.pub3
    • Iron deficiency anaemia. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised September 2018
    • Intrauterine contraceptive device. Patient – Professional Reference. patient.info/plus, last updated May 2019
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    • Tranexamic acid. NICE British National Formulary. bnf.nice.org.uk, accessed February 2021
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  • Reviewed by Sarah Smith, Freelance Health Editor and Alice Windsor, Specialist Health Editor, Bupa, February 2021
    Expert reviewer, Dr Madhavi Vellayan, Consultant Gynaecologist
    Next review due May 2024

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