Menorrhagia
Heavy periods, also known as menorrhagia, are menstrual bleeding that affects your physical, emotional or social wellbeing. You may need to change sanitary protection frequently, pass large clots or bleed for longer than usual. Heavy bleeding can disrupt daily activities and cause tiredness or iron deficiency, so assessment and treatment can help.
Commonality
Causes
Heavy menstrual bleeding can occur for a variety of reasons.
Common causes include:
Hormonal imbalance affecting ovulation
Bleeding disorders such as von Willebrand disease
Thyroid disorders
Certain medications, including blood thinners
Hormonal changes during perimenopause
In some cases, no clear cause is identified.
Symptoms
Symptoms of heavy periods may include:
Bleeding that:
soaks through pads or tampons every 1–2 hours
fills a menstrual cup regularly
Passing large blood clots
Periods lasting longer than 7 days
Needing to use both pads and tampons together
Waking overnight to change sanitary protection
Fatigue
Dizziness
Breathlessness due to anaemia (low blood count)
Effects on Fertility
Diagnosis
A thorough assessment is usually needed to identify the cause of heavy bleeding.
Investigations may include:
Detailed menstrual and medical history
Pelvic examination
Transvaginal ultrasound
Saline sonohysterography
Blood tests to assess anaemia, thyroid function and clotting disorders
MRI scanning when endometriosis, adenomyosis or complex fibroids are suspected
These investigations help guide treatment and identify any underlying conditions.
Treatments
Treatment depends on the cause of the bleeding, symptom severity and future pregnancy plans.
Medical treatments
Tranexamic acid to reduce menstrual blood loss
Iron supplements to treat iron-deficiency anaemia
Minimally invasive procedures
Hysteroscopy to remove polyps or small fibroids
Endometrial ablation (burning away lining of womb)
Endometrial biopsy to investigate abnormal bleeding
Surgical options
Myomectomy to remove fibroids while preserving the uterus
Hysterectomy in selected cases when other treatments have not been effective
Ongoing Care
Living with the Condition
Heavy periods can have a significant impact on physical, emotional and social wellbeing. Many women experience:
Persistent fatigue and low energy
Anxiety about bleeding through clothing
Dependence on frequent sanitary protection
Disruption to work, exercise and social activities
Iron-deficiency anaemia
Effective treatment can significantly improve quality of life and reduce the impact of symptoms.
When to See a Specialist
You should consider specialist assessment if:
Periods are becoming heavier or lasting longer than usual
Bleeding is affecting daily activities
You experience fatigue, dizziness or symptoms of anaemia
You are passing large blood clots
Symptoms are worsening over time
Early assessment can help identify treatable causes and prevent complications such as iron-deficiency anaemia.