Heavy Periods (Menorrhagia)

heavy periods

Heavy periods are common. In most cases no cause can be found. In some cases a cause is found such as endometriosis, fibroids, and other conditions (listed below). In most cases treatment is effective by using medication to reduce bleeding, or by surgery.

What is a normal period, a heavy period, and menorrhagia?

About 1 in 3 women describe their periods as heavy. Some medical definitions of blood loss during a period are:

  • A normal period is a blood loss between 20 and 60 ml.Bleeding can last up to eight days, but bleeding for five days is average.A heavy period is a blood loss of 60-80 ml or more.
  • For practical purposes, a period is probably heavy if it causes one or more of the following:
  • Flooding through to clothes or bedding.
  • You need frequent changes of sanitary towels or tampons.
  • You need double sanitary protection (tampons and towels).
  • You pass large blood clots.

Menorrhagia means heavy periods that recur each month. Also, that the blood loss interferes with your quality of life. Menorrhagia can occur alone or in combination with other symptoms.

What causes recurring heavy periods?

The cause is not known in most cases

This is called dysfunctional uterine bleeding and is the cause of heavy periods in four to six out of ten cases. l and the periods are usually regular. It is more common if you have recently started your periods or if you are approaching the menopause.

Other causes

These are less common. They include the following:

  • Fibroids. These are benign (noncancerous) growths in the muscle of the uterus.(see separate leaflet called 'Fibroids' ).
  • Other conditions of the uterus, such as endometriosis (see separate leaflet called 'Endometriosis'), infections or polyps, may lead to heavy periods. Cancer of the lining of the uterus (endometrial cancer) is a very rare cause.
  • Polycystic ovary syndrome.
  • Hypothyroidism
  • The intrauterine contraceptive device (IUCD, or coil) sometimes causes heavy periods.
  • Pelvic infections.
  • Warfarin or similar medicines interfere with blood clotting. If you take one of these medicines for other conditions, it may have a side-effect of heavier periods.
  • Some drugs used for chemotherapy can also cause heavy periods.
  • Blood clotting disorders are rare causes of heavy bleeding. Other symptoms are also likely to develop, such as easy bruising or bleeding from other parts of the body.

Do I need any tests if I have heavy periods?

A doctor may want to do an internal (vaginal) examination .However, an examination is not always necessary, especially in younger women who do not have any symptoms to suggest anything other than dysfunctional uterine bleeding.

  • A blood test to check for anaemia.
  • If the vaginal examination is normal (as it is in most cases), and you are under the age of 40, no further tests are usually needed.

Any woman where a doctor detects a large or abnormal uterus, or who has other symptoms which may indicate an underlying problem. For example, if you:

  • Bleed between periods, or have irregular bleeding.
  • Have bleeding or pain during, or just after, sex.
  • Have pain apart from normal period pains.
  • Have any change in your usual pattern of bleeding, particularly if you are over the age of 40.
  • Have symptoms suggesting a hormonal problem or blood disorder.

If tests are advised then they may include one or more of the following:

  • An ultrasound scan of your uterus.,can usually detect any fibroids, polyps, or other changes in the structure of uterus.
  • Internal swabs. This may be done if an infection is the suspected cause of the heavy bleeding
  • Endometrial sampling. This is where a thin tube is passed into the uterus. Gentle suction is used to obtain small samples (biopsies) of the uterine lining (endometrium).
  • Hysteroscopy. This is where a doctor can look inside the uterus. A thin telescope is passed into your uterus through your cervix via the vagina. This too can often be done without an anesthetic. Small samples can also be taken during this test.
  • Blood tests. For example, if an underactive thyroid gland or a bleeding disorder is suspected.
  • How bad symptoms are, and whether treatment is needed.
  • If treatment is started, to assess if it is helping. Some treatments take a few menstrual cycles to work fully

What are the treatment options for heavy periods?

Not treating

This is an option if your periods do not interfere too much with normal life. You may be reassured that there is no serious cause for your heavy periods, and you may be able to live with them. A blood test may be advised every so often to check for anaemia. Iron tablets can correct anaemia.

Levonorgestrel intrauterine system (LNG-IUS)

This treatment usually works very well. The LNG-IUS is similar to an intrauterine contraceptive device (IUCD, or coil). In most women, bleeding becomes either very light or stops altogether within 3-6 months of starting this treatment. Period pain is usually reduced too. The LNG-IUS is a long-acting treatment. Each device lasts five years, although it can be taken out at any time. it is also a reliable form of contraception.

Tranexamic acid tablets

Tranexamic acid tablets are an option if the LNG-IUS is not suitable or not wanted If side-effects occur they are usually minor, but may include an upset stomach.

Anti-inflammatory painkillers

Your doctor may prescribe ones called mefenamic acid or naproxen. These medicines reduce the blood loss by about a third (20-50%) in most cases. They also ease period pain.

The combined oral contraceptive pill (COCP)

This reduces bleeding by at least a third in most women. It often helps with period pain too. It is a popular treatment with women who also want contraception

The contraceptive injection and the contraceptive implant also tend to reduce heavy periods.If you require contraception then one of these may be an option for you.


Norethisterone is a progestogen medicine. It is not commonly used to treat heavy periods. It is sometimes considered if other treatments have not worked,The reason why norethisterone is not commonly used as a regular treatment is because many women get side-effects, such as bloating, fluid retention, breast tenderness, nausea, headache and dizziness.

Surgical treatment

Having surgery is not a first-line treatment. It is an option if the above treatments do not help or are unsuitable:

Removing or destroying the lining of the uterus is an option. This is called endometrial ablation or resection. This can be done by various ways such as by using heat, microwaves, and cryotherapy. This treatment prevents women from having children in the future.

Hysterectomy is the traditional operation where the uterus is totally removed. However, hysterectomy is done much less commonly these days since endometrial ablation became available. It may be considered if all other treatment options have not worked for you.

A note for teenagers with heavy periods

Heavy periods due to dysfunctional uterine bleeding seem to be more common in the first few years after starting periods. If you are a teenager and have heavy periods, you have a good chance that they will settle down over a few years and become less heavy.


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