Heavy Menstrual Bleeding: Causes and Treatment

Heavy menstrual bleeding, also called menorrhagia, means periods so heavy or long that they disturb your daily life or leave you tired and short of iron. It is common, it has many treatable causes, and you do not have to put up with it.

This guide covers the signs, what can cause it, why anaemia matters, how doctors investigate it and what treatments exist.

How do I know my periods are too heavy?

Doctors can define heavy bleeding by the amount of blood lost, usually more than 80 mL per cycle. In real life nobody measures this, so doctors rely on your symptoms and how the bleeding affects your life. A review of clinical guidelines in PubMed Central notes that the UK's NICE also diagnoses it when heavy bleeding affects your physical, social, emotional or material quality of life.

The NHS and Cleveland Clinic list these common signs:

• Changing a pad or tampon every 1 to 2 hours, or for several hours in a row
• Needing to use two products at once, or to change them at night
• Periods lasting more than 7 days
• Passing clots larger than about 2.5 cm (a quarter-sized clot or more)
• Bleeding through to clothes or bedding
• Avoiding exercise, work or social plans because of bleeding
• Feeling tired, breathless or dizzy

Cleveland Clinic estimates that heavy bleeding affects roughly 27 to 54 percent of people who menstruate, while the review above gives 18 to 38 percent. Whatever the exact figure, it is very common.

Why is anaemia a concern?

Blood contains iron, and heavy periods can drain your iron stores. Low iron can lead to iron-deficiency anaemia, which causes tiredness, weakness, headaches, pale skin and breathlessness. The PubMed Central guideline review calls iron deficiency in women with heavy bleeding likely underdiagnosed and undertreated. The NHS says blood tests are used to check for iron-deficiency anaemia.

If you often feel exhausted during or after your periods, mention it. Read more in our guide to anaemia in women.

Common causes

Sometimes heavy periods are normal for you or are linked to life stages. The NHS says they can be heavier at puberty, after pregnancy or near menopause. Other causes include:

• Hormone imbalance. When ovulation is irregular, the womb lining can build up and then shed heavily. This is common in PCOS and thyroid disease. See PCOD vs PCOS.
• Fibroids and polyps. Non-cancerous growths in or on the womb. See uterine fibroids.
• Adenomyosis and endometriosis. The womb lining grows in the womb wall or elsewhere in the pelvis.
• Pelvic infection. Pelvic inflammatory disease and some sexually transmitted infections.
• Bleeding disorders such as von Willebrand disease.
• Medicines and devices. Blood thinners, some hormonal treatments and non-hormonal copper coils can increase bleeding.
• Pregnancy problems, including miscarriage and ectopic pregnancy.
• Rarely, cancer of the womb lining or cervix, and some liver or kidney conditions.

Cleveland Clinic also lists being overweight and approaching menopause as risk factors.

When to be cautious: if you soak through two or more pads or tampons an hour for two to three hours, feel faint, or have a racing heart or severe pain, treat it as an emergency and go to hospital. Heavy bleeding in early pregnancy needs urgent care too. Our emergency page can help.

What tests might you have?

Your doctor will ask about your cycle, flow, clots, family history, medicines, contraception and pregnancies, then examine you. Cleveland Clinic lists these common tests:

• Blood tests for anaemia, iron stores, clotting and thyroid function.
• Pelvic ultrasound, the most common scan, to look for fibroids, polyps or cysts.
• Other checks where needed, such as a Pap smear, a sample of the womb lining, a camera look inside the womb (hysteroscopy) or an MRI.

Tip: keep a period diary for two or three cycles. Note the start and end date, how often you change pads, clot sizes and pain. This gives your doctor a clear picture faster than memory.

Treatment options

Treatment depends on the cause, how severe the bleeding is, your age, whether you want children, and your preferences. Some mild cases improve without treatment.

Medicines (usually tried first)

• Iron treatment to correct low iron or anaemia. Guideline reviews generally put iron tablets first, with iron by drip for severe cases or when tablets fail.
• Hormonal treatments such as the contraceptive pill or a hormone-releasing coil, which can make bleeding lighter.
• Medicines taken during periods that reduce bleeding or cramps, such as non-hormonal tablets or anti-inflammatory painkillers.
• Treating the cause, such as thyroid disease, infection or a clotting disorder.

Do not start these without a prescription. Some are unsuitable if you smoke, have a clotting history, or are planning pregnancy.

Procedures and surgery

If medicines fail or a structural cause is found, your specialist may discuss removing polyps or fibroids, blocking the blood supply to fibroids, removing or destroying the womb lining (not advised if you want more children), or hysterectomy as a last resort. The NHS lists removal of the womb lining, fibroid removal and hysterectomy as options. Ask about benefits, risks, recovery time and effect on future pregnancy. You can read more about hysterectomy and minimally invasive surgery.

Self-care while you wait for treatment

• Eat iron-rich foods, such as green leafy vegetables, dals, ragi, jaggery in small amounts, eggs, fish or meat, along with vitamin C foods such as lemon or guava to help absorption. Ask your doctor before starting an iron supplement.
• Stay hydrated and rest when tired.
• Use a warm compress for cramps.
• Change pads or tampons regularly, at least every 4 to 6 hours, as Cleveland Clinic advises, and avoid leaving a tampon in overnight if you are prone to infection.
• Carry spare supplies and wear dark clothing on heavy days if it helps your confidence.

When to see a doctor

The NHS says to see a doctor if heavy periods affect your life or have lasted a while. Book a visit soon if you have:

• Periods that last more than 7 days or are getting heavier
• Bleeding between periods or after sex
• Severe pelvic pain, fever or foul-smelling discharge
• Tiredness, dizziness or breathlessness that does not improve
• Heavy bleeding with pain when passing urine, passing stools or during sex
• Any bleeding after menopause

Our reproductive care team can help you plan the next steps, and you may like our guide to menstrual disorders.

Talk to a doctor

If you have questions about your own situation, you are welcome to book an appointment or call us on +91 944 103 0587. Chaitanya Hospital in Kadapa offers 24/7 delivery and emergency care, and teleconsultation is available. This article is for general awareness and is not a substitute for a doctor's advice.