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Heavy periods (menorrhagia)


Expert reviewer Robin Crawford, Consultant Gynaecologist.
Next review due October 2019

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

Around a third of women in the UK say they get heavy periods.

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About heavy periods

The amount of blood lost 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. But 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

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 help show if you might have heavy periods.

  • You need to change your sanitary towel a lot (you soak through a sanitary pad or tampon every hour for several hours in a row).  
  • You find you have to double up on sanitary protection (use a tampon and a towel at the same time) to prevent leaks. 
  • You pass large blood clots. 
  • You bleed through to your clothes or bedding.

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

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

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

  • Blood tests to check the level of haemoglobin in your blood, along with your iron level and hormones to check how well your thyroid is working.  
  • 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 abdomen 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.  
  • A pregnancy test. This is to check that your bleeding isn’t because of a complication related to being pregnant.

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

Treatment of heavy periods

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 your doctor can’t find what’s causing them, they’ll give you treatments to ease your symptoms. The treatment you have will also depend on other things. These include 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.

  • Intrauterine system (IUS) or Mirena coil. 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.
  • Tranexamic acid. This 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 also help to reduce painful periods and make your periods more regular.  
  • Progestogen. 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.

Non-surgical treatments

If medicines don’t help you, 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. 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 which will block the blood vessels and thus cause the fibroids to shrink.

Surgical treatment

Endometrial ablation

In an endometrial ablation operation, a surgeon will destroy or remove most of your womb lining using energy such as microwaves or heat. If you want to have children in the future, this treatment isn’t an option.

Myomectomy

This is an operation to remove fibroids. Your doctor may suggest you have this operation if you want to have children in the future. There are other alternative procedures to treat fibroids. See our topic on fibroids for more information about these.

Hysterectomy

A hysterectomy is an operation to remove your womb. It’s a major operation so it’s usually only done 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

Doctors don’t yet understand the exact reasons why some women have heavy periods. About half of women who have heavy periods don’t ever find out why. But some conditions can make heavy periods more likely. These include:

  • fibroids or polyps (growths of tissue) in your womb 
  • endometriosis (when cells that normally line your womb grow in other parts of your body)  
  • an infection, such as pelvic inflammatory disease 
  • conditions that affect how your blood clots  
  • an underactive thyroid 
  • getting older – most women who get them are between 30 and 49 
  • womb cancer or cervical cancer – but this is rarely the cause

Some women have heavy periods when they start their menopause. And if you’re taking anticoagulant medicines, such as warfarin, or have an intrauterine contraceptive device (IUD or coil) fitted, these can both cause heavy periods.

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. 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 cause mood swings and affect your sex life, so it’s important to get help from 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 GP if you're trying to get pregnant, or want to have children in the future, as this will affect your treatment choices.

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

    Side-effects are the unwanted effects of 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. Initially, they may be irregular or last longer. This usually settles in to light bleeding or no bleeding a few months after you have the IUS put in. You may also have other side-effects such as tender breasts, migraines, and pain in your back and tummy.

    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, including what’s causing your heavy periods.

    Your treatment will depend on whether or not your GP can find a cause for your heavy periods, and if so, what this is. Medicines and non-surgical treatments are usually used first to ease your symptoms, reduce the heavy bleeding and prevent you getting anaemia.

    Your GP 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.


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Related information

    • Heavy menstrual bleeding. National Institute for Health and Care Excellence (NICE), 26 September 2013. www.nice.org.uk  
    • Assessment of menorrhagia. BMJ Best Practice. bestpractice.bmj.com, last updated 21 September 2015 
    • Menorrhagia. PatientPlus. www.patient.info/patientplus, last checked 24 February 2016 
    • Gynaecology. Oxford handbook of general practice (online). Oxford Medicine Online. oxfordmedicine.com, published April 2014 
    • Pelvic examination technique. Medscape. emedicine.medscape.com, updated 17 March 2016 
    • Menorrhagia. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised August 2015 
    • Ray S, Ray A. Non-surgical interventions for treating heavy menstrual bleeding (menorrhagia) in women with bleeding disorders. Cochrane Database of Systematic Reviews 2014, Issue 11. doi:10.1002/14651858.CD010338.pub2 
    • Clinical recommendations on the use of uterine artery embolisation (UAE) in the management of fibroids. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published December 2013 
    • Uterine fibroids. BMJ Best Practice. bestpractice.bmj.com, last updated 7 December 2015 
    • Dysfunctional uterine bleeding. BMJ Best Practice. bestpractice.bmj.com, last updated 26 October 2015 
    • Anemia. Medscape. emedicine.medscape.com, updated 22 July 2016 
    • Contraception – IUS/IUD. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised October 2015 
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 31 August 2016
    • Heavy menstrual bleeding: assessment and management. National Institute for Health and Care Excellence (NICE), 24 January 2007. www.nice.org.uk  
    • Pelvic inflammatory disease. BMJ Best Practice. bestpractice.bmj.com, last updated 25 April 2016
  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, October 2016
    Expert reviewer Robin Crawford, Consultant Gynaecologist
    Next review due October 2019



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