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Heavy periods (menorrhagia)


Expert reviewer, Miss Shirin Irani, Consultant Obstetrician and Gynaecologist
Next review due December 2021

Heavy periods are when your periods are consistently so heavy that they interfere with your daily life. The medical name for heavy periods is menorrhagia.

Around a third of women in the UK say they get heavy periods. Most women are between 30 and 49 when they get them.

An image showing the female reproductive system

About heavy periods (menorrhagia)

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

Doctors class heavy periods as when you lose 80ml of blood (or more) each period. As you can imagine, this is very difficult to measure, so heavy periods aren’t diagnosed this way. The diagnosis has more to do with how much your periods interfere with your life, both emotionally and physically.

Symptoms of heavy periods (menorrhagia)

It can be difficult to tell how much blood you’re losing each month because it often looks much more than it is. Here are some signs to look out for that help show if you might have heavy periods.

  • You need to change your sanitary products a lot (you soak through a sanitary pad or tampon every hour for several hours in a row).
  • You have to upgrade the level of products you use, such as using superplus tampons.
  • You have to double up on sanitary protection (use a tampon and a towel at the same time or two towels) to prevent leaks.
  • You pass large blood clots.
  • You bleed through to your clothes or bedding (this is called flooding).
  • You bleed for more than seven days during your period.

If your periods affect your normal activities such as going out, working or shopping, this may also be a sign that they’re heavy.

It’s possible these signs may indicate that your heavy periods are caused by something else. So it’s a good idea to go and see your GP for advice. Also see your GP if you have:

  • bleeding between periods 
  • pain or bleeding after sex 
  • tummy pain

Diagnosis of heavy periods (menorrhagia)

Your GP will ask about your symptoms and examine you. They’ll also ask you about your medical history.

Your GP might refer you to see a gynaecologist (a doctor who specialises in women’s reproductive health).

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

  • Blood tests. These will check the level of haemoglobin (a protein that carries oxygen) in your blood, and how well your blood clots.
  • A pregnancy test. This is to check that your bleeding isn’t because of a complication related to being pregnant.
  • An internal examination. Your GP will put an instrument called a speculum inside your vagina to look at your vagina and cervix. They might also do a ‘bimanual examination’. This involves them putting their fingers (they’ll wear gloves) into your vagina while pressing on your tummy at the same time with the other hand. This is to check for tenderness and changes to your womb.
  • An ultrasound. An ultrasound uses sound waves to produce an image of your womb.
  • An endometrial biopsy. This is a procedure to collect a sample of your endometrium (the tissue that lines your womb).
  • Hysteroscopy. This is a procedure to look inside your womb (uterus).

Treatment of heavy periods (menorrhagia)

If your GP finds a cause for your heavy periods, they may treat that condition or refer you for treatment with a specialist. Your heavy periods should then improve.

If you don’t have a condition that’s causing heavy periods, treatment focuses on easing your symptoms. The treatment you have will depend on things like your age, if you’re planning to have children, and if you have any other health problems.

Medicines

Medicines can reduce the amount of bleeding you have and ease your symptoms. The main ones are listed below.

  • Tranexamic acid. This medicine can reduce how much you bleed.
  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as mefenamic acid. These have been shown to reduce how much you bleed and can ease pain.
  • The combined contraceptive pill. This can help to reduce painful periods and make your periods more regular.
  • Progestogen-only contraceptive. This will also reduce how much you bleed. You can take this as a tablet or have an injection. The injection also acts as a contraceptive.

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.

Devices

Intrauterine system (IUS)

This is a small plastic device that’s put into your womb and slowly releases a hormone called levonorgestrel. This hormone reduces the lining of your womb making it thinner, which means you should bleed less. This gives you contraception as well as treating heavy periods.

Non-surgical treatments

If medicines don’t help, you might need to try non-surgical treatments.

Uterine artery embolisation

If your heavy periods are caused by fibroids, this might be a treatment option for some women. However, this treatment isn’t suitable for everybody. Ask your doctor if it’s an option for you.

A 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’ll then inject a chemical that will block the blood vessels and shrink the fibroids.

Surgical treatment

Endometrial ablation

In an endometrial ablation operation, a surgeon will use energy, such as electricity or heat, to destroy or remove most of your womb lining. If you want to have children in the future, this treatment may not be an option – ask your doctor for advice.

Myomectomy

This 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 alternative procedures to treat fibroids. You can learn about these in our topic on fibroids.

Hysterectomy

A hysterectomy is an operation to remove your womb. This is the only cure for heavy periods. But it’s a major operation so usually, you’ll only have this if all other treatments haven’t worked. After a hysterectomy, you won’t have periods anymore and can’t have children.

Causes of heavy periods

About half of women who have heavy periods don’t ever find a cause. But some conditions can make heavy periods more likely. These include:

  • fibroids or polyps (growths of tissue) in your womb – these can affect the lining of your womb and cause heavy bleeding
  • polycystic ovary syndrome (PCOS) – this condition can make your periods irregular, and they can be heavy when they start again
  • adenomyosis – this is when cells that normally line your womb grow into the muscle wall of your womb
  • 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)
  • an underactive thyroid – this can make your womb lining thicker than usual so when it sheds during your period, it will cause heavy bleeding
  • your age – the risk increases with age and most women who get them are between 30 and 49
  • being overweight – body fat produces a hormone called oestrogen, which can make the lining of the womb overgrow and become thick, causing heavy bleeding when shed
  • conditions that affect how your blood clots, such as von Willebrand disease
  • womb cancer or cervical cancer – but this is rarely the cause of heavy periods

Some women have heavy periods during what’s called the perimenopause period, just before they start their menopause. An intrauterine contraceptive device (IUD or coil) can cause heavy periods, as can taking anticoagulant medicines.

Complications of heavy periods (menorrhagia)

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. This means your blood carries less oxygen than you need. This can make you feel tired and out of breath, and give you pale skin. Around two-thirds of women with heavy periods have iron-deficiency anaemia.

Heavy periods can be distressing and can make you feel self-conscious and embarrassed during your period. Understandably, they can make you feel low and affect your sex life, so it’s important to talk about these things with your GP.

Frequently asked questions

  • Heavy periods alone won’t usually affect your chances of getting pregnant. But some of the causes of heavy bleeding can make it more difficult to conceive. For example, fibroids can affect your fertility and make it more difficult to get pregnant. Pelvic inflammatory disease can also cause infertility.

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

  • Yes, medicines and devices for 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 or Mirena) fitted, you might notice that the pattern and length of your periods changes. At first, they may be irregular or last longer. This usually settles in to 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.

    If you’re taking tranexamic acid, you might feel sick, be sick or have diarrhoea. Non-steroidal anti-inflammatory drugs (NSAIDs) can cause indigestion and heartburn, and make asthma worse. If you’re taking the combined oral contraceptive pill, you may get headaches or feel depressed.

    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. There may be another option for you.

  • This will depend on your individual circumstances and whether or not your doctor can find a cause for your heavy periods. Medicines and non-surgical treatments are usually used first to ease your symptoms, reduce the heavy bleeding and prevent you getting anaemia.

    Your specialist doctor will go through your treatment options with you. Things to consider include:

    • 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 heavy periods haven’t worked. The type of surgery you have will depend on your symptoms, what condition you have and if you want children. Ask your doctor to talk through your options with you.


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Related information

    • Heavy menstrual bleeding: assessment and management. National Institute for Health and Care Excellence (NICE), March 2018. www.nice.org.uk
    • Assessment of menorrhagia. BMJ Best Practice. bestpractice.bmj.com, last reviewed 18 September 2018
    • Menorrhagia. PatientPlus. patient.info/patientplus, last checked 24 February 2016
    • Gynaecology. Oxford handbook of general practice. Oxford Medicine Online. oxfordmedicine.com, published April 2014
    • Heavy menstrual bleeding. American College of Obstetricians and Gynecologists. www.acog.org, published June 2016
    • Personal communication, Miss Shirin Irani, Consultant Obstetrician and Gynaecologist, 6 November 2018
    • Heavy menstrual bleeding. NICE British National Formulary. bnf.nice.org.uk, reviewed 22 October 2018
    • Pelvic examination technique. Medscape. emedicine.medscape.com, reviewed 25 September 2018
    • Menorrhagia. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised June 2017
    • Contraceptives, hormonal. NICE British National Formulary. bnf.nice.org.uk, reviewed 22 October 2018
    • Fibroids. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised March 2018
    • Polycystic ovary syndrome. PatientPlus. patient.info/patientplus, last reviewed 24 June 2016
    • Hapangama DK, Bulmer JN. Pathophysiology of heavy menstrual bleeding. Womens Health (Lond) 2016; 12(1):3–13. doi:10.2217/whe.15.81
    • Anaemia. PatientPlus. patient.info/patientplus, last checked 1 November 2017
    • Pelvic inflammatory disease. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised August 2018
    • Contraception – IUS/IUD. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised July 2016
    • Tranexamic acid. NICE British National Formulary. bnf.nice.org.uk, reviewed 22 October 2018
    • Non-steroidal anti-inflammatory drugs. NICE British National Formulary. bnf.nice.org.uk, reviewed 22 October 2018
  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, December 2018
    Expert reviewer, Miss Shirin Irani, Consultant Obstetrician and Gynaecologist
    Next review due December 2021



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