The Heavy Periods Decoder

A practical guide to understanding heavy menstrual bleeding — what it means, when to act, and what to expect from assessment.

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Start Here

Heavy menstrual bleeding (menorrhagia) is one of the most common reasons women see a gynaecologist. It is not something you should just live with. If your period regularly disrupts your daily life, it is worth investigating.

Signs your bleeding may be heavy:

• Soaking through a pad or tampon every hour or two
• Needing to change protection during the night
• Passing clots larger than a 20-cent coin
• Bleeding for more than 7 days
• Avoiding work, exercise, or social activities because of your period
• Feeling exhausted, dizzy, or short of breath around your period

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Common Causes

Heavy periods can result from several conditions — sometimes more than one at a time:

• Fibroids — non-cancerous growths in or on the uterus
• Adenomyosis — tissue similar to the uterine lining growing into the muscle wall
• Polyps — small growths on the lining of the uterus
• Hormonal imbalance — including anovulatory cycles or thyroid problems
• Clotting disorders — especially if heavy periods started from your first cycle
• Endometrial concerns — particularly in women over 40 or with risk factors

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What to Track Before Your Appointment

• How many days your period lasts
• How often you change pads or tampons (and whether they are fully soaked)
• Whether you pass clots, and how large
• Any days missed from work or activities
• Any symptoms between periods: pain, spotting, fatigue

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What Assessment Usually Includes

• A clinical history and examination
• Blood tests: full blood count (to check for anaemia), iron studies, thyroid function, and clotting screen where relevant
• Pelvic ultrasound
• Sometimes a hysteroscopy (a camera look inside the uterus) or endometrial biopsy

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Treatment Options

Treatment depends on the cause, your symptoms, and whether you want to preserve fertility.

Medical options:

• Hormonal treatment (pill, IUD, or other)
• Tranexamic acid to reduce bleeding
• Iron replacement if anaemic
• Anti-inflammatory medication for pain and flow

Surgical options (when medical treatment is not enough):

• Polypectomy or fibroid removal
• Endometrial ablation
• Hysterectomy (as a last resort, when family is complete)

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Your Next Step

If heavy periods are affecting your quality of life, the next step is a structured assessment — not another month of hoping it gets better.

Bring your bleeding diary, any previous blood results or scan reports, and a list of what you have already tried.