What are heavy periods?

It can sometimes be difficult to know if you have particularly heavy periods because what is normal changes from person to person. However, the following signs would suggest your periods are heavy:

• You have to get up in the night to change your sanitary products.
• You need to use more than one sanitary product at once (e.g. both a pad and a tampon).
• You have to change your sanitary products once every one or two hours.
• You’re passing blood clots more than 2cm across.
• You’re bleeding for longer than a week.

It’s worth seeing the doctor if this applies to you, or if you’ve simply noticed your periods getting heavier. You should also see a doctor if you’re having period pain or bleeding between your periods. Left untreated, heavy periods can lead to iron deficiency anaemia.

What causes heavy periods?

Common causes of heavy periods include fibroids (non-cancerous growths in the womb) or endometriosis. Less common causes include:

• pelvic inflammatory disease
• polycystic ovarian syndrome
• polyps
• adenomyosis
• a hormonal imbalance caused by hypothyroidism, obesity or diabetes
• a blood clotting disorder such as Von Willebrand disease
• certain medications such as hormonal medication or anticoagulants
• using “the coil”, a type of contraception
• womb cancer or cervical cancer

Almost half of cases of heavy bleeding have no underlying cause.

What happens when you see a doctor for heavy periods?

When you visit the doctor, they will ask you about your medical history, symptoms, and any medication you’re on, and you might need to keep a diary of your bleeding. You might also have a number of tests depending on the suspected cause, including:

• a full blood test to test for iron deficiency or a blood-clotting disorder
• hysteroscopy to look inside the womb
• an ultrasound to produce an image of the tissues inside your uterus and pelvis

How are heavy periods treated?

There are many treatment options for heavy periods and it’s important that you and the doctor discuss in detail your personal preferences and future childbearing plans.

Conservative treatment options include:

• non-steroidal anti-inflammatory drugs such as ibuprofen
• tranexamic acid
• hormonal medication such as the combined oral contraceptive pill or cyclical progestogen
• an intrauterine system (IUS), an implantable device that slowly releases progestogen over time.

If these treatments are unsuccessful, or if you have fibroids or endometriosis, there are a number of procedures available aimed at removing the tissue causing the problem, including:

• uterine artery embolisation
• ultrasound surgery
• myomectomy

If you are getting lots of fibroids or severe endometriosis, and you are no longer planning to have children, endometrial ablation or hysterectomy may be recommended treatment options.