Heavy Periods (Heavy Menstrual Bleeding)

Heavy periods, or heavy menstrual bleeding, means losing an unusually large amount of blood during your period. Because what is normal varies from person to person, the practical definition is bleeding heavy enough to affect your quality of life — for example, needing to change pads or tampons very frequently, passing large clots, bleeding through to clothes or bedding, or having to plan around your periods.

It is a common problem and, on its own, is not usually a sign of anything serious. However, because ongoing heavy bleeding can lower your iron levels and affect daily life, and can occasionally point to an underlying condition, it is worth having it assessed.

As well as heavy bleeding, you may pass large blood clots, need to use double protection, change protection every hour or two, or bleed for more than about a week. Heavy blood loss can cause tiredness, breathlessness, and other signs of iron-deficiency anemia.

Bleeding between periods, bleeding after sex, or any bleeding after the menopause is different from heavy periods and should always be checked, as it needs separate assessment.

In many cases no underlying cause is found. When there is one, common causes include fibroids (non-cancerous growths in the womb), polyps, endometriosis or adenomyosis, polycystic ovary syndrome (PCOS), and hormonal changes such as around the perimenopause.

Less commonly, heavy bleeding is related to a bleeding disorder, an intrauterine device (IUD), certain medicines, thyroid problems, or, rarely, a growth in the womb lining that needs to be excluded. Finding or ruling out a cause helps guide treatment.

A doctor asks about your periods and general health and may examine you. A blood test checks for iron-deficiency anemia, and sometimes for thyroid or clotting problems.

An ultrasound of the womb and ovaries can look for fibroids, polyps, or other causes. In some cases, a thin camera passed into the womb (hysteroscopy) or a sample of the womb lining is taken, particularly to exclude other conditions in women who need it.

Treatment depends on the cause, your symptoms, and whether you wish to have children in future. Medicines are often the first step: these include a hormonal intrauterine device (IUD) that thins the womb lining, hormonal treatments such as the combined pill, and non-hormonal options such as tranexamic acid and anti-inflammatory medicines taken during periods. Treating anemia with iron is important if your levels are low.

If medicines do not help or there is a specific cause, procedures may be offered. Endometrial ablation removes or thins the womb lining, and fibroids or polyps can be removed (for example by myomectomy or hysteroscopic surgery). For some women who have completed their family and have not responded to other treatments, a hysterectomy is an option. Your team explains the choices so you can decide what suits you.

The outlook is good. Heavy periods can almost always be improved, and there is a wide range of treatments to suit different needs and preferences, including whether you want to preserve fertility. Treating any anemia also helps you feel better.

Heavy periods cannot usually be prevented, but getting them assessed means any underlying cause — such as fibroids — can be found and treated, and the right option chosen for you. Keeping your iron levels up supports your energy while treatment takes effect.