Gynaecology › Heavy Periods
Heavy Periods
How much menstrual bleeding counts as "normal" varies from woman to woman. The measure is not a number but whether it affects your life: missing work, getting up at night to change protection, constant tiredness — these are findings that deserve assessment.
When bleeding is considered heavy
- Bleeding lasting longer than 7 days
- Soaking a pad or tampon every hour
- Passing clots larger than a coin
- Signs of anaemia: fatigue, palpitations, breathlessness, pallor
- Daily life restricted by the bleeding
Main causes
- Fibroids and endometrial polyps
- Adenomyosis
- Hormonal disturbance (absent ovulation, thyroid disease)
- The effect of an intrauterine device
- Bleeding and clotting disorders
- Excessive thickening of the lining of the womb
- Certain medications
How it is investigated
Examination and ultrasound identify most causes. A full blood count shows the degree of anaemia, and thyroid and, where indicated, clotting tests are assessed.
If a polyp or submucosal fibroid is suspected, hysteroscopy allows the cavity to be seen directly and the lesion removed at the same sitting. In the appropriate age group, a sample of the womb lining may be required.
Treatment options
- Iron treatment where there is anaemia — this should not be neglected
- Medication to reduce bleeding
- A hormone-releasing intrauterine system
- Hysteroscopic removal of a polyp or fibroid
- Procedures directed at the womb lining in selected cases
- Surgery where other methods prove insufficient
When to seek help without waiting
- Soaking more than one pad in an hour
- Faintness, palpitations and breathlessness
- Any bleeding after the menopause
- Bleeding when pregnancy is possible
