Heavy menstrual bleeding is one of the most common reasons women come to this clinic, and one of the most under-reported conditions in gynecology. The reason is simple: you have only ever had your own periods. If yours have always been heavy, heavy is what normal looks like to you.
So instead of asking whether your periods are heavy, it is more useful to ask whether any of the following is true.
Signs your bleeding is worth investigating
- You soak through a pad or tampon every one to two hours on your heaviest days
- You need double protection — a tampon and a pad together
- You bleed for more than seven days
- You pass clots larger than a rupee coin
- You have to get up at night to change protection
- You have had flooding accidents through clothing
- You plan your work, travel or studies around your period
- You feel exhausted, breathless or dizzy, particularly after your period
That last one deserves emphasis. Heavy periods are the most common cause of iron deficiency anaemia in women, and the tiredness it causes is frequently blamed on stress, work, or simply getting older for years before anyone connects it to the bleeding. If you are exhausted and your periods are heavy, those two facts are usually the same fact.
What it usually turns out to be
Heavy bleeding is a symptom, not a diagnosis. In practice the cause is most often one of these.
Fibroids
Non-cancerous growths in the muscle of the uterus. Extremely common, frequently harmless, but depending on size and position they can cause heavy bleeding, pressure and pain. Found on ultrasound.
Adenomyosis
Where the lining tissue grows into the muscular wall of the uterus. Classically causes heavy bleeding together with worsening period pain, often in women in their thirties and forties who have had children.
Polyps
Small growths in the lining of the uterus or on the cervix. Often cause bleeding between periods or after sex as well as heavy periods.
Hormonal causes
Cycles where ovulation does not occur reliably — common in the years after periods first start, in the years approaching menopause, and in PCOS — lead to a lining that builds up unpredictably and sheds heavily.
Thyroid problems
An underactive thyroid is a genuinely common and easily missed cause. It is a single blood test.
Bleeding disorders
Inherited clotting problems, of which von Willebrand disease is the most common, often present as heavy periods from the very first one. Worth considering if you have bled heavily since adolescence, or bruise easily.
Contraception
A copper IUD commonly increases bleeding. This is expected rather than alarming, but it is treatable and worth raising.
What the tests involve
Usually straightforward and, at this clinic, usually the same visit:
- Haemoglobin and ferritin — to see whether the bleeding has made you anaemic and depleted your iron stores
- Thyroid function — one blood test
- Pelvic ultrasound — to look for fibroids, adenomyosis, polyps and ovarian causes
- A sample of the uterine lining — not needed for most younger women, but important if you are over 45, or have risk factors, or bleed between periods
What can be done about it
A great deal, and much of it does not involve surgery. Options depend on the cause, on whether you want to become pregnant, and on what you are willing to take.
- Tranexamic acid — a non-hormonal tablet taken only during your period that reduces bleeding substantially in many women
- Anti-inflammatory painkillers — reduce both bleeding and pain, taken during the period
- A hormonal IUD — one of the most effective treatments available for heavy bleeding, and it doubles as contraception
- The combined pill or progestogen tablets — regulate the cycle and reduce flow
- Iron replacement — corrects the anaemia, which is often what is actually making you feel terrible
- Treatment aimed at the cause — removing a polyp, or treating fibroids, where that is what is driving it
Surgery exists and sometimes it is the right answer, but it is rarely the first one.
When not to wait
Come the same day, or go to the nearest hospital, if you are soaking a pad in under an hour, feel faint or breathless, have severe pain with the bleeding, or have any bleeding at all after your periods have stopped for a year or more. That last one is not a heavy-periods question — postmenopausal bleeding always needs assessment, and usually turns out to be something benign, but it is checked promptly for a reason.
The thing worth taking away
Heavy periods are common. Common is not the same as normal, and it is certainly not the same as untreatable. Women routinely lose years to exhaustion and disrupted work over something that a blood test, a scan and a tablet would have substantially resolved.
Our heavy periods self-check guide gives you a simple way to record two cycles before you come in.
A note on this article
This is general information, not advice about your particular situation — no article can replace being examined. If something here matches what you’re experiencing, that is a reason to come in, not a reason to self-treat. Walk in during clinic hours or call +91 93660 92897.