Heavy periods
How much blood is lost in a period is something a woman has nothing to compare with: nobody has seen anyone else's, so her own seems ordinary.
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Medicines commonly prescribed for Heavy periods
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: ORAL SOLUTION/SUSPENSION, 4 g / 100 mlActive substance: ibuprofenManufacturer: Italfarmaco S.A.Prescription not requiredDosage form: TABLET, 400 mgActive substance: ibuprofenManufacturer: Laboratorios Cinfa S.A.Prescription not requiredDosage form: TABLET, 400 mgActive substance: ibuprofenManufacturer: Laboratorios Cinfa S.A.Prescription required
How much blood is lost in a period is something a woman has nothing to compare with: nobody has seen anyone else's, so her own seems ordinary. That is why many spend years with blood loss that crossed the line long ago, putting the constant tiredness down to work and short nights. Heavy periods are not a character trait and not the price of anything: they have identifiable causes and treatment that works in most cases. What follows is how to tell heavy from normal, what lies behind it, and why waiting for it to "settle on its own" is a poor plan.
What counts as heavy bleeding
Nobody is going to measure the loss in millilitres, so everyday markers are used instead. Your periods are heavy if at least one of these describes you:
- you have to change a pad or tampon every one to two hours, or empty a cup more often than the instructions allow;
- you use two products at once, a tampon with a pad on top;
- you get up in the night to change;
- the bleeding lasts more than seven days;
- you pass clots larger than two and a half centimetres;
- blood leaks through onto clothes and bedding;
- you arrange your life around your period: cancelling training, staying in, taking a day off, choosing clothes on the principle of what will not show;
- towards the end of the period you feel weak, breathless going upstairs, or notice your heart racing.
That last point is the most underrated. Month after month heavy periods drain iron out of the body and iron deficiency sets in: the stores fall first, and only later does the haemoglobin drop. Hence the tiredness that a weekend does not fix, feeling cold all the time, hair falling out, brittle nails and trouble concentrating. That is not "normal for a woman", it is treatable, and it starts with a blood test.
Where the extra blood comes from
Some women have always had heavy periods, investigation finds nothing, and that too is a version of normal: the lining of the womb simply sheds more generously. It happens particularly in the first years after periods begin and during the run-up to the menopause, when the cycle loses its rhythm — ovulation does not happen every month, the lining grows thicker than usual and comes away with more difficulty.
But if periods have become heavier than they used to be, there is usually something behind it:
- Fibroids, benign lumps in the wall of the womb. This is the commonest finding, and the ones growing into the cavity cause the heaviest bleeding.
- Polyps of the womb lining, and thickening of the lining itself.
- Adenomyosis, where lining tissue grows into the muscular wall: the classic combination is heavy and very painful periods with an enlarged womb.
- Endometriosis and past pelvic inflammatory disease.
- Hormonal upsets — polycystic ovary syndrome and an underactive thyroid.
- Bleeding disorders. These get a paragraph of their own below, because they are almost never considered.
- Medicines and intrauterine devices — blood thinners, some kinds of chemotherapy, and the non-hormonal copper coil, which in itself makes periods heavier and longer.
- Cancer of the body or neck of the womb — an uncommon but real cause, and the reason the investigations are done at all.
Clotting deserves a closer look. If your periods were heavy from the very first one and have stayed that way, and on top of that you bruise easily, bleeding from a small cut or from the nose takes a long time to stop, or you bled for a long time after a tooth extraction or a birth, that is a reason to have the clotting system checked. The commonest of these conditions, von Willebrand disease, affects roughly one woman in a hundred, and in many it is never identified because heavy periods get put down to "it runs in the family, my mother was the same". Something does run in the family — it simply has a name and a treatment.
Signs that cannot wait
Call an ambulance (in Europe, the single number 112) if:
- a maximum-absorbency pad soaks through every hour for two hours running or longer;
- you feel dizzy, your vision darkens, you have fainted, your skin is pale and your heart is racing;
- sudden one-sided pain low in the abdomen with bleeding and a late period — that is how an ectopic pregnancy can present, and it is an emergency.
See a doctor within the next few days, rather than putting it off, if you start bleeding between periods or after sex, if there is any bleeding at all once the menopause has passed, if periods have suddenly become far heavier than before, or if they come with pain that was not there previously. None of this means something terrible has happened, but these are precisely the signs that decide how quickly you are investigated.
What to bring to the appointment and what gets checked
It helps to arrive prepared: for two or three cycles, note the days of bleeding, how many pads or tampons you get through in a day, whether there were clots and leaks, and how you felt. Such a diary replaces half an hour of questions and shows the picture at a glance. Write down all the medicines and supplements you take as well, and think back to who in the family has had heavy bleeding.
After that the usual steps are:
- a full blood count and an assessment of iron stores — done almost always, because deficiency needs treating whatever the cause;
- a gynaecological examination and, where appropriate, a cervical smear;
- a pelvic ultrasound, best done just after the period ends: it shows fibroids, polyps, the thickness of the lining and signs of adenomyosis;
- a pregnancy test if pregnancy is possible;
- thyroid tests and clotting studies — not for everyone, but where the history points that way;
- hysteroscopy with a biopsy of the lining: an inspection of the cavity of the womb with a slim camera passed through the neck of the womb, when the lining itself has to be examined.
How it is treated
Heavy periods can be treated even when investigation has found nothing: what is treated is the blood loss and its consequences, not the finding. The choice depends on whether you are hoping to conceive, whether you also need contraception, and whether there is pain.
- The hormone-releasing intrauterine system is the most effective option for heavy periods. It thins the lining of the womb, blood loss falls several times over, and in some women periods eventually stop altogether. It stays in for several years and doubles as contraception. Spotting in the first months is common and worth sitting out.
- Tranexamic acid — non-hormonal tablets taken only on bleeding days. It suits women hoping to conceive or preferring to avoid hormones.
- Anti-inflammatory painkillers reduce both the loss and the pain at once, and are likewise taken only during the period.
- Combined contraceptive pills make periods shorter and lighter, while single-hormone preparations are used when combined ones are unsuitable.
- Iron is a compulsory part of treatment where there is a deficiency. It is not a fortnight's course but several months: the haemoglobin rises first, and refilling the stores takes considerably longer. The dose and the follow-up tests are the doctor's decision.
If your periods became heavy after a copper coil was fitted, the conversation begins with changing the method. And if the first treatment did not suit you, that is not a dead end: a second or third usually does.
When a procedure comes into the conversation
Surgical options come up when medicines have not worked, or when there is a growth that cancels out their effect.
- Removing a polyp or a fibroid, often through the neck of the womb with no incisions. The womb is preserved and pregnancy remains possible.
- Uterine artery embolisation for fibroids: their blood supply is cut off through a fine catheter and they shrink.
- Endometrial ablation, the destruction of the inner lining of the womb. It is a short and minimally invasive procedure, but only suits women certain they do not want a pregnancy, and it requires reliable contraception afterwards.
- Removal of the womb, a definitive solution kept as a last resort, once everything else has been tried or where there are separate reasons for it.
None of these is decided in a single appointment: each carries its own implications for a future pregnancy and its own recovery.
Online consultation
A remote appointment works well as a first step. Working from your diary, the doctor can judge whether the loss really is excessive, take the history — how the cycle has changed, what you take, whether female relatives had heavy bleeding — and say which tests and which scan are worth arranging before you are seen in person, so that you do not arrive at the gynaecologist empty-handed. It is also the place to deal with iron deficiency and how to take iron properly, to sort out the side effects of a treatment already prescribed, and to work out what to do if it has not helped. Examination, ultrasound and fitting a coil cannot be done at a distance, and heavy bleeding happening right now, with weakness and fainting, is a reason to call an ambulance rather than book a consultation.
This material is for information only and does not replace medical advice.
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