Knowledge Centre · Patient guide
The Heavy Periods Decoder
A practical guide to heavy menstrual bleeding: what it means, when to act, and what to expect from assessment.
A practical guide to understanding heavy menstrual bleeding: what it means, when to act, and what to expect from assessment.
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
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
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
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
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)
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.
Sources and guidance
- Heavy menstrual bleeding: assessment and management (NG88), National Institute for Health and Care Excellence
- Heavy menstrual bleeding, American College of Obstetricians and Gynecologists
Your next step
You should not have to plan your month around your period. This is where it gets assessed:
Free, and yours to keep Check whether your bleeding meets the clinical definition →
Prices are what you pay, not an estimate. We confirm your own fee after a short eligibility and affordability check, and there is no obligation.
Rather just talk it through?
Tell us what you have read and what you are worried about. We call you back. You do not need a referral, and nothing is booked until you say so.