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Periods - heavy

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Learn more about periods - heavy: introduction

Heavy periods are common, but they can have a big effect on a woman's everyday life.

They don't always have an underlying cause, but they can result from problems such as fibroids or endometriosis, so it's important to get your symptoms checked out.

See your GP if:

  • you're worried about your bleeding
  • your periods have got heavier
  • you're also having other symptoms, such as period pain or bleeding between your periods

Various treatments are available for heavy periods, including:

  • some types of contraception, like an intrauterine system (IUS) or the combined pill
  • medicines, like tranexamic acid
  • surgery

How much is heavy bleeding?

It's difficult to define exactly what a heavy period is because it varies from woman to woman. Heavy for one woman may be normal for another.

Most women will lose less than 16 teaspoons of blood (80ml) during their period, with the average being around 6 to 8 teaspoons.

Heavy menstrual bleeding is defined as losing 80ml or more in each period, having periods that last longer than 7 days, or both.

However, it's not usually necessary to measure blood loss. Most women have a good idea of how much bleeding is normal for them during their period and can tell when this changes.

A good indication that your periods are heavy is if you:

  • are having to change your sanitary products every hour or two
  • are passing blood clots larger than 2.5cm (about the size of a 10p coin)
  • are bleeding through to your clothes or bedding
  • need to use two types of sanitary product together – for example, tampons and pads

What causes heavy periods?

In about half of women with heavy menstrual bleeding, no underlying reason is found. But there are several conditions and some treatments that can cause heavy menstrual bleeding.

Some conditions of the womb and ovaries can cause heavy bleeding, including:

  • fibroids – non-cancerous growths that develop in or around the womb and can cause heavy or painful periods
  • endometriosis – where the tissue that lines the womb (endometrium) is found outside the womb, such as in the ovaries and fallopian tubes (although this is more likely to cause painful periods)
  • adenomyosis – when tissue from the womb lining becomes embedded in the wall of the womb; this can also cause painful periods
  • pelvic inflammatory disease (PID) – an infection in the upper genital tract (the womb, fallopian tubes or ovaries) that can cause symptoms like pelvic or abdominal pain, bleeding after sex or between periods, vaginal discharge and fever
  • endometrial polyps – non-cancerous growths in the lining of the womb or cervix (neck of the womb)
  • cancer of the womb – the most common symptom is abnormal bleeding, especially after the menopause
  • polycystic ovary syndrome (PCOS) – a common condition that affects how the ovaries work; it causes irregular periods, and periods can be heavy when they start again

Other conditions that can cause heavy periods include:

Medical treatments that can sometimes cause heavy periods include:

  • an IUD (intrauterine contraceptive device, or "the coil") – this can make your periods heavier for the first 3 to 6 months after insertion
  • anticoagulant medication – taken to prevent blood clots
  • some medicines used for chemotherapy
  • some herbal supplements, which can affect your hormones and may affect your periods – such as ginseng, ginkgo and soya

Seeing a GP and further tests

Your GP will start by asking you about your heavy bleeding, any changes to your periods and any other symptoms you have, like bleeding between your periods or period pain.

All women who have heavy periods should be offered a blood test to check for iron deficiency anaemia.

The GP may also suggest a physical examination or refer you for further tests to try to find out if there's an underlying cause for your heavy periods. Further tests may include:

  • other blood tests
  • an ultrasound scan
  • a hysteroscopy – where a narrow telescope with a light and camera at the end is passed into the womb through the vagina to examine the inside of the womb

Read more about diagnosing heavy periods.

Treating heavy periods

There are various treatment options for heavy periods. These depend on what's causing your heavy periods, your general health and your preferences.

They include:

  • an intrauterine system (IUS) – a small device that contains the hormone progestogen is inserted in your womb by a medical professional (often the first treatment offered)
  • medicines without hormones – such as tranexamic acid or non-steroidal anti-inflammatory drugs (NSAIDS)
  • medicines with hormones – such as the combined oral contraceptive pill or progestogen tablets
  • endometrial ablation – a procedure to remove the lining of the womb
  • myomectomy – surgery to remove fibroids
  • uterine artery embolisation – a procedure to shrink fibroids
  • hysterectomy – surgery to remove to the womb

Read more about treating heavy periods.

Content supplied by NHS website

Learn more about periods - heavy: diagnosis

See a GP if you feel your periods are unusually heavy or have become heavier. They'll investigate the problem and may offer treatments to help.

Seeing a GP

To try to find out what's causing your heavy periods, your GP will ask about:

  • your medical history
  • what your bleeding is like – for example, how long your periods normally last and how often you need to change sanitary products
  • any related symptoms you have, like period pain or bleeding between periods
  • what effect your bleeding is having on your everyday life

Your GP may also want to know what type of contraception you're currently using, whether you plan to have a baby in the future and the last time you had a cervical screening test.

You'll also be asked about your family history to rule out inherited conditions that may be causing your heavy bleeding, such as Von Willebrand disease, which runs in families and affects blood clotting.

Blood tests

A full blood test should be offered to all women with heavy periods.

This can identify iron deficiency anaemia, which is often caused by heavy periods. If you have iron deficiency anaemia, you'll usually be prescribed iron tablets.

Some women may be offered an additional blood test to check for blood clotting disorders.

Physical examination

Your GP may suggest a physical examination to try to find the cause of your heavy bleeding.

You should be offered the option to be examined by a female doctor.

A physical examination involves the doctor:

  • pressing on your tummy to feel for any abnormalities
  • looking at your cervix by using an instrument called a speculum to hold open the walls inside your vagina
  • feeling the inside of your vagina to identify whether your womb or ovaries are tender or enlarged

Before carrying out a pelvic examination, your doctor will explain the procedure to you and why it's necessary.

You should ask about anything you're unsure about. A pelvic examination should not be carried out without your consent.

Further tests

If they have not been able to identify the underlying cause of your heavy periods, your doctor may refer you for further tests. These will check for abnormalities in the womb or ovaries, such as fibroids or adenomyosis.

These tests are usually done in hospital.

Hysteroscopy

This is a procedure to examine the inside of your womb. It involves a narrow telescope with a light and camera at the end being passed into your womb through your vagina.

Images are sent to a monitor, so your doctor or specialist nurse can see inside your womb.

Sometimes a biopsy is carried out at the same time. This involves removing a small sample of womb lining for closer examination under a microscope.

Find out more about having a hysteroscopy.

Ultrasound scan

You may be referred for an ultrasound scan of your womb as an alternative to hysteroscopy.

The ultrasound can be done from outside your body (pelvic ultrasound) or from inside your vagina (transvaginal ultrasound) depending on your circumstances.

For a transvaginal ultrasound, a small probe is inserted into your vagina to get a close-up image of your womb.

Content supplied by NHS website

Learn more about periods - heavy: treatment

Various treatments options are available for heavy periods.

Not all the treatments may be suitable for you. What treatment options you are offered will depend on:

  • your symptoms
  • your general health
  • the underlying cause of your heavy periods, if there is one
  • whether you're trying for a baby or want to get pregnant in the future
  • your personal preferences

You should discuss benefits and risks of the different options with your doctor, including any impact on future fertility from some treatments.

Intrauterine system (IUS)

The IUS, or levonorgestrel-releasing intrauterine system, is a small plastic device inserted into your womb by a doctor or nurse. It slowly releases a hormone called progestogen.

It prevents the lining of your womb growing quickly and is also a contraceptive. An IUS doesn't affect your chances of getting pregnant after you stop using it.

Possible side effects of using an IUS include:

An IUS is often the preferred first treatment for women with heavy menstrual bleeding, but it can take at least 6 periods for you to start seeing the benefits.

Read more about the IUS.

Tranexamic acid

You may be prescribed tranexamic acid tablets if an IUS is unsuitable or you're waiting for further tests or another treatment.

The tablets work by helping the blood in your womb to clot.

Tranexamic acid tablets are usually taken 3 times a day for a maximum of 4 days. You start taking the tablets as soon as your period starts.

Tranexamic acid tablets are not a form of contraception and won't affect your chances of becoming pregnant. If necessary, tranexamic acid can be combined with a non-steroidal anti-inflammatory drug (NSAID).

Possible side effects of tranexamic acid include:

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs can also be used to treat heavy periods if an IUS isn't appropriate, or if you're waiting for further tests or a different treatment.

They're taken in tablet form from the start of or just before your period, until heavy bleeding has stopped.

NSAIDs used for treating heavy menstrual bleeding include:

Mefenamic acid and naproxen are only available on prescription.

NSAIDs work by reducing your body's production of a hormone-like substance called prostaglandin, which is linked to heavy periods. NSAIDs can also help relieve period pain. They're not a form of contraceptive.

You can keep taking NSAIDs for as long as you need to if they're making your bleeding less heavy and not causing significant side effects.

Make sure you do not take more than the recommended daily dose listed on the packet.

Combined oral contraceptive pill

The combined contraceptive pill can be used to treat heavy periods. It contains the hormones oestrogen and progestogen.

The benefit of using combined oral contraceptives as a treatment for heavy periods is they offer a more readily reversible form of contraception than the IUS.

They also have the benefit of regulating your menstrual cycle and reducing period pain.

The pill works by preventing your ovaries releasing an egg each month. As long as you're taking it correctly, it should prevent pregnancy.

Common side effects of the combined oral contraceptive pill include:

  • mood changes
  • feeling sick (nausea)
  • headaches
  • breast tenderness

Read more about the combined pill.

Cyclical progestogens

If other treatments have not helped, you may be offered a type of medicine called cyclical progestogen.

It's taken in tablet form for part of your menstrual cycle. Your doctor will advise you how to take it.

It's not an effective form of contraception and can have unpleasant side effects, including:

  • breast tenderness
  • bleeding between your periods

Endometrial ablation

Endometrial ablation involves thinning, removing or destroying the lining of the womb (the endometrium). It may lighten your periods or stop them all together, depending on how much of your womb lining remains.

Different techniques can be used for endometrial ablation, including:

  • endometrial ablation using heat – an electrical source, radio waves or lasers are used to destroy the womb lining via the vagina and cervix
  • endometrial ablation using ultrasound energy – high levels of ultrasound energy from outside the body are used to destroy fibroids without harming healthy womb lining

These procedures can be carried out either under local anaesthetic or general anaesthetic. They're fairly quick, and you can usually go home on the same day.

You may experience some vaginal bleeding, like a light period, for a few days after endometrial ablation. Use sanitary towels rather than tampons. Some women can have bloody discharge for 3 or 4 weeks.

You may also experience tummy cramps, like period pains, for a day or two after the procedure. These can be treated with painkillers, such as paracetamol or ibuprofen.

Some women have reported experiencing more severe or prolonged pain after having endometrial ablation. In this case, you should speak to your GP or a member of your hospital care team who may be able to prescribe a stronger painkiller.

It's unlikely you'll be able to get pregnant after endometrial ablation. If you do, you'll have an increased risk of miscarriage or other complications. The procedure is not recommended if you still want to have children.

Sometimes, endometrial ablation does not lighten the periods, or the heavy periods may come back. If this happens you may be offered a repeat treatment.

Uterine artery embolisation (UAE)

If your heavy periods are caused by fibroids, UAE may be an option.

This involves blocking the blood vessels that supply the fibroids, causing them to shrink. Under X-ray guidance, a small tube is inserted into the large blood vessel in your thigh.

Small particles are injected through the tube to block the arteries supplying blood to the fibroid.

Read more about UAE on our page about treatments for fibroids.

Myomectomy

Myomectomy is another treatment option for heavy periods caused by fibroids. It involves surgery to remove fibroids from the wall of your womb.

Read more about myomectomy on our page about treating fibroids.

Removal of the womb (hysterectomy)

A hysterectomy will stop any future periods but should only be considered after other options have been tried or discussed.

The operation and recovery time are longer than for other types of surgery for treating heavy periods.

You won't be able to get pregnant after having a hysterectomy.

A hysterectomy is only used to treat heavy periods after a thorough discussion with your specialist about the benefits and disadvantages of the procedure.

Content supplied by NHS website