Menorrhagia (Heavy Periods)

A period is typically considered to be heavy if:

• You need to change your tampon, or sanitary pad every one to two hours for several hours in a row
• You use more than one type of sanitary product at the same time
• You have to get up during the night to change your pad or tampon
• Your period lasts longer than seven days
• You leak through onto your clothes or bedsheets
• You pass blood clots larger than a ten-pence piece
• You take time off work or avoid activities because of your period
• You have signs of anaemia such as weakness, tiredness, pale skin, and shortness of breath

When to see a doctor

See a doctor if you feel your periods are heavier than they should be, are heavier than usual, or interfere with your ability to carry out normal activities.

Some causes of heavy periods include:

Hormonal imbalance

An imbalance of the female sex hormones oestrogen and progesterone can result in heavy periods. Hormonal imbalances can be caused by conditions such as polycystic ovarian syndrome (PCOS), thyroid disorders, obesity, and insulin resistance. Heavy periods due to fluctuations in hormone levels can also occur during perimenopause, the months or years leading up to menopause.

Intrauterine device (IUD)

Some types of IUDs that do not contain hormones can cause heavy periods.

Pregnancy complications

Bleeding in pregnancy may be a sign of complications such as miscarriage or ectopic pregnancy (where the foetus grows outside the womb). If you experience any bleeding while you are pregnant, seek immediate medical attention.

Endometriosis

This is a chronic (long-term) condition where tissue similar to the lining of the womb (the endometrium) grows in areas outside the womb like the fallopian tubes, ovaries, and bowel. Symptoms include painful periods and bleeding or spotting between periods.

Pelvic inflammatory disease (PID)

PID is a condition where there is inflammation of the reproductive tract including the fallopian tubes, womb, and ovaries. It is normally caused by an untreated sexually transmitted infection such as chlamydia or gonorrhoea. Symptoms of PID include pain during sex, lower abdominal pain, and bleeding between periods.

Sexually transmitted infections (STIs)

STIs including chlamydia, gonorrhoea, and trichomoniasis can cause heavy periods.

Fibroids

Fibroids are a type of non-cancerous tumour that grow in the uterus (womb). Symptoms include heavy periods, back pain, and pain during sex. Small fibroids may not need treatment, but if your fibroids are large or causing symptoms, they can be treated with medication or surgery.

Uterine polyps

These are small, non-cancerous growths on the lining of the womb. They may not cause any symptoms but can be a cause of heavy or prolonged menstrual bleeding. They can be treated with medication or surgery.

Adenomyosis

A condition where tissue from the lining of the uterus grows into the uterine wall making the uterus larger than normal. Adenomyosis may not have any symptoms but can cause heavy, painful periods, pain during sex, and infertility. The condition can be treated with pain medication, hormonal birth control, or in severe cases, a hysterectomy (surgical removal of the womb).

Gynaecological cancers

Cancer of the uterus, cervix, or ovaries can be a cause of heavy bleeding, particularly after menopause.

Bleeding disorders

Conditions such as von Willebrand's disease interfere with the blood's ability to clot and can cause heavier than normal periods

Medications

Medicines that thin the blood like aspirin and warfarin, hormonal medications, and anti-inflammatories can contribute to heavy periods.

Medical conditions

A variety of medical conditions, including liver or kidney disease, can make periods heavier.

At your first appointment with Circle Health Group, you will be seen by a consultant gynaecologist, a doctor specialising in conditions affecting the female reproductive system.

Your consultant will ask you some questions about your menstrual cycle. These may include:

• How old were you when your periods started?
• How long on average is your cycle? (the number of days between your periods)
• How many days does your period usually last?
• How many days do you feel your period is heavy?
• How does your period affect your quality of life?
• What method of contraception do you use?
• When was your last smear test?
• Do you have a family history of heavy periods?

Your consultant will also ask you about your general health, medical history, and any medications you are taking. They will perform a physical examination and order any necessary tests or scans.

These may include:

• Blood tests - for iron deficiency anaemia and any underlying health conditions that could cause heavy periods like thyroid problems or blood clotting disorders
• Smear test - to check for abnormal cells, inflammation, or infection of your cervix
• Endometrial biopsy - samples of tissue are taken from your endometrium (the lining of the womb) to check for abnormal cells
• Ultrasound - a painless scan that uses sound waves to create images of your organs and allows your consultant to examine your uterus, ovaries, and fallopian tubes

Depending on the results of your initial tests your consultant may order:

• Sonohysterography - this is a safe and painless procedure where a slim ultrasound probe is inserted through your vagina into your uterus. Ultrasound uses high-frequency sound waves to create real-time images of your uterus. A salty fluid is injected into your uterus through a catheter to make the images clearer. Sonohysterography can be used to diagnose problems with your uterus that may be causing your heavy periods
• Hysteroscopy - this involves inserting a hysteroscope, an instrument like a telescope with a light and camera at the end, through your vagina into your uterus. Images of your uterus are sent to a monitor so that your consultant can examine them for abnormalities. It can be used to diagnose problems or to remove fibroids, polyps, or displaced IUDs. Hysteroscopy may be done under local or general anaesthetic and is usually carried out as a day case, though in some cases you may need to spend one night in hospital

Why is this first consultation so important?

At Circle Health Group, your first appointment is very important as it's where your consultant will ask you about your symptoms, perform a physical examination, order any necessary tests, provide a diagnosis, and discuss possible treatments.

Your first consultation is also where we get to know you, discuss your expectations for treatment, and encourage you to ask any questions you may have. It is important to us that you are as well-informed and comfortable as possible during your time with us, so please ask your consultant any questions you may have.

After making a diagnosis, your consultant will discuss possible treatment options with you. The best treatment for you will depend on many factors including:

• Your diagnosis
• Your general health and medical history
• Whether or not you plan to have children in the future
• The effect your heavy periods have on your quality of life
• Your opinion and preferences

Treatment for heavy periods depends on the cause as well as your individual circumstances and preferences. Heavy periods can sometimes be treated with medication, but in some cases, surgery may be necessary.

• Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen help relieve menstrual cramps and may reduce bleeding. In some women, NSAIDs can increase the risk of bleeding
• Tranexamic acid is a medication that controls bleeding by helping your blood to clot. You only need to take it while you are bleeding
• Oral progesterone can help to correct hormonal imbalances and reduce menstrual bleeding
• Oral contraceptives help to regulate your cycle and can reduce heavy periods
• Hormonal IUDs thin the lining of the uterus and decrease cramping and heavy bleeding during your period
• Iron supplements may be necessary if you have iron deficiency anaemia due to heavy periods

There are a variety of operations available to treat heavy periods. The one you are recommended will depend on various factors personal to you, including your age and whether you have completed your family, as well as the cause and severity of your symptoms.

Dilation and curettage (D&C)

During this procedure, the cervix is dilated, and tissue is scraped or suctioned from the lining of the uterus. The procedure is often effective at reducing heavy menstrual bleeding but may need to be done more than once if heavy bleeding returns.

Uterine artery embolization

This is a treatment for fibroids where a catheter is inserted into an artery in the thigh and guided to the arteries in the uterus. An injection is then given to cut off the blood supply to the fibroids causing them to shrink.

Endometrial ablation

In this procedure a laser or heat is used to destroy the lining of the uterus resulting in lighter periods. This procedure is not recommended if you want to have children in the future.

Endometrial resection

The lining of the uterus is removed using an electrosurgical wire loop. Like endometrial ablation, pregnancy is not recommended after this procedure.

Focused ultrasound surgery

This is a non-invasive procedure where ultrasound waves are used to destroy fibroid tissue and shrink fibroids.

Myomectomy

Myomectomy is the surgical removal of fibroids. It may be performed through open abdominal surgery, laparoscopically (through several small incisions in the abdomen), or hysteroscopically (through the vagina and cervix). The type of surgery depends on the size and number of fibroids, and where they are located.

Hysterectomy

This is the removal of your cervix and uterus. It results in the permanent end of your periods and stops you from being able to get pregnant. If you have your ovaries removed at the same time (bilateral oophorectomy) this will trigger immediate menopause. A hysterectomy is performed under general anaesthetic and requires a stay in hospital

If left untreated heavy periods can lead to problems with your health such as:

Psychological problems

Being unable to participate in normal activities like working and going out can lead to isolation, depression, and stress.

Iron deficiency anaemia

This is a condition where there is not enough iron in your blood. Your body needs iron to make red blood cells. Iron deficiency anaemia is diagnosed with a simple blood test and can be treated with iron supplements.

Symptoms of iron deficiency anaemia include:

• Extreme tiredness (fatigue)
• Weakness
• Pale skin
• Fast heartbeat
• Chest pain
• Shortness of breath
• Cold hands and feet
• Brittle nails
• Sore and inflamed tongue

We answer some of your most commonly asked questions about heavy periods.

Why is my period so heavy this month?

Sometimes your period may be heavier than normal for no apparent reason, or it may be due to underlying factors like hormonal imbalance, uterine polyps, fibroids, or pregnancy complications. The only way to find out for sure what is causing your heavy periods is to get checked out by a doctor. If your periods are heavy or have suddenly become heavier, make an appointment with a doctor.

How do you stop heavy periods?

How to stop heavy periods depends on the cause. Your doctor will run some tests to find out what is causing your heavy periods and recommend treatment depending on your diagnosis, whether or not you want to have children in the future and how much your heavy period is affecting your life. Treatments include medications to correct hormonal imbalances and reduce bleeding and surgery to remove fibroids, polyps, or the lining of your womb.

Can you have a heavy period and still be pregnant?

It isn't possible to have a period when you are pregnant. Bleeding or spotting during pregnancy is caused by something other than your period and may be a sign that something is wrong with the pregnancy. If you experience bleeding or spotting at any stage of your pregnancy, seek immediate medical attention.

Can heavy periods cause anaemia?

Yes. If you lose a lot of blood during your period it can cause a condition called iron deficiency anaemia. Symptoms include fatigue, weakness, and shortness of breath. Your doctor can check whether you have iron deficiency anaemia with a blood test. The condition is treated with iron supplements.

Can stress cause heavy periods?

When we are stressed we release stress hormones such as cortisol that may disrupt our levels of reproductive hormones and impact our menstrual cycle. One study¹ found a link between high levels of stress and an increase in symptoms of premenstrual syndrome (PMS), amenorrhea, (absence of periods), and dysmenorrhea (period pain). More research is needed to say for sure whether stress can be a cause of heavy periods.

At Circle Health Group we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant best suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about treatment for heavy periods, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in December 2022. Next review due December 2025.

1. Menorrhagia (heavy menstrual bleeding), Mayo Clinic
2. Heavy Menstrual Bleeding, Centers for Disease Control and Prevention
3. Heavy periods (heavy menstrual bleeding) , NHS Inform
4. Heavy periods, NHS
5. Prevalence of menstrual problems and their association with psychological stress in young female students studying health sciences, PubMed