Heavy Periods: Signs, Causes and When to See a Doctor

Heavy periods are very common, and for some people they are simply their normal pattern. Even so, they can get in the way of work, exercise and sleep, and sometimes a treatable condition is behind them. This article explains what heavy bleeding looks like, why it happens and when it is time to talk to a doctor.

What counts as a heavy period?

Heavy periods are also called menorrhagia. They can happen to anyone who has periods. According to the NHS, you may have heavy periods if you:

• need to change a pad or tampon every 1 to 2 hours, or need to empty a menstrual cup more often than the maker advises
• need to use two products at once, such as a pad and a tampon
• have periods that last more than 7 days
• pass blood clots bigger than about 2.5 cm, roughly the width of a small coin
• leak through to your clothes or bedding
• avoid everyday things such as exercise, or take time off work, because of your periods
• often feel tired or short of breath

The NHS notes that periods can be heavier when they first start, after pregnancy and as you get close to menopause. Feeling tired or breathless can be a sign that heavy bleeding is affecting your body, so do not ignore it.

What can cause heavy periods?

Often there is no single clear cause, but the NHS lists several possible ones:

• Conditions of the womb or ovaries. These include polycystic ovary syndrome (PCOS), fibroids, endometriosis, adenomyosis and pelvic inflammatory disease.
• Bleeding disorders. Some conditions, such as von Willebrand disease, make you bleed more easily.
• Some medicines and treatments. Certain blood thinners (anticoagulants) and some chemotherapy drugs can make periods heavier.
• Rarely, womb cancer.

This is why a doctor may want to look further if your bleeding is a big change for you or does not settle.

How heavy periods are checked

If treatment does not help, or a doctor suspects an underlying condition, you will usually be referred for tests or to a specialist. The NHS says you may have a series of blood tests to look for conditions such as iron deficiency anaemia, which can happen when you lose a lot of blood over time. Depending on what the doctor suspects, they may arrange other checks.

It can help to note down how often you change products, how long your periods last, and whether you have pain or bleeding between periods. This gives your doctor a clearer picture.

Treatment options

Heavy periods do not always need treatment, but there are options when they affect daily life. The NHS describes these general approaches, and a doctor decides what suits each person:

• Treatments a family doctor can start. These include some kinds of contraception, such as a hormonal coil (intrauterine system) or the combined pill, a medicine that reduces bleeding, and prescription-only anti-inflammatory painkillers.
• Specialist treatments. These include removing the lining of the womb (endometrial ablation), removing fibroids if they are thought to be the cause, and hysterectomy, which means removing all or part of the womb.

Each option has its own benefits and risks, and some are not suitable if you hope to become pregnant. Talk this through with your doctor. Do not stop or change any prescribed treatment without talking to your doctor.

When to see a doctor

The NHS suggests seeing a doctor if:

• your heavy periods are affecting your life
• you have had heavy periods for some time
• your periods are very painful
• you bleed between periods or after sex
• you have heavy periods along with pain when you pee, poo or have sex

Also seek care if you feel unusually tired or short of breath, because that can be a sign of low iron. If you feel faint, dizzy, or are soaking through pads very quickly and feel unwell, get urgent medical help.

In an emergency, call your local emergency number (112 in India, 911 in the United States).

Key points

• Heavy periods are common, but you do not have to put up with them if they disrupt your life.
• Signs include changing products every 1 to 2 hours, clots larger than about 2.5 cm and periods lasting over 7 days.
• Causes range from PCOS, fibroids and endometriosis to bleeding disorders and certain medicines.
• Treatment depends on the cause, and a doctor will guide the choice.