Excessive menstrual bleeding not only reduces comfort and quality of life but can also lead to anaemia caused by iron deficiency, fatigue, and, in some cases, indicate more serious problems within the reproductive system or general health.
If you experience symptoms such as unusually heavy bleeding, prolonged cycles, significant weakness during your period, or signs of anaemia, we encourage you to book a consultation with one of our gynaecologists at our practice in Harrow.
Our doctors specialise in diagnosing and treating menstrual disorders, including heavy periods. We provide comprehensive care – from medical history and ultrasound examination to advanced laboratory testing.
This article explains the most common causes of excessive menstrual bleeding, available diagnostic methods, and treatment options – both medical and surgical.
How to Tell the Difference Between Normal and Heavy Periods
A normal menstrual period usually lasts between three and seven days, with an average blood loss of up to 80 ml. Bleeding should be regular, moderate, and free from large clots, without causing major discomfort. For most women, this means changing a pad or tampon every three to four hours without leakage or the need for double protection.
Bleeding is considered heavy when:
- You need to change pads or tampons every hour or more often.
- You pass large blood clots.
- Your period lasts longer than seven days.
- Your cycles become irregular or shorter than 21 days.
- You develop symptoms of anaemia, such as fatigue, pale skin, dizziness, or palpitations.
In such cases, medical assessment is essential to identify the underlying cause. Heavy bleeding can result from anatomical changes within the reproductive organs (such as fibroids), hormonal imbalance, or systemic conditions like blood clotting disorders. Early gynaecological evaluation helps establish the cause and begin the treatment to prevent complications.
The Most Common Causes of Heavy Periods – What Can Cause Excessive Bleeding?
Heavy menstrual bleeding can have many causes – both local (related to the reproductive organs) and systemic (linked to general health). Some are temporary, while others require specialist or surgical treatment.
1. Hormonal Imbalance
This is especially common among teenage girls and women approaching menopause, when cycles may be anovulatory. An imbalance between oestrogen and progesterone can cause excessive growth of the uterine lining (endometrium), leading to heavy or irregular bleeding.
2. Uterine Fibroids and Other Anatomical Changes
Benign muscle tumours in the uterus, known as fibroids, are one of the most frequent causes of prolonged and heavy periods. When located beneath the endometrium (submucosal fibroids), they can interfere with uterine contractions and increase blood loss. Endometrial polyps or endometrial hyperplasia can also lead to excessive bleeding.
3. Endometriosis and Adenomyosis
In endometriosis, endometrial tissue grows outside the uterus, which may cause painful and very heavy periods. Adenomyosis – where the uterine lining grows into the muscular wall of the uterus – is another condition that often leads to increased menstrual flow and pelvic pain.
4. Blood Clotting Disorders and Haematological Conditions
Some women have undiagnosed congenital bleeding disorders, which may first present as heavy or prolonged menstrual bleeding. The problem may also worsen with the use of anticoagulant medications.
5. Intrauterine Devices (IUDs)
Traditional copper IUDs can increase menstrual bleeding, particularly in women who already experience heavy periods. In contrast, hormonal intrauterine systems (such as those containing levonorgestrel) often reduce bleeding and may even stop periods altogether in some cases.
6. Other Contributing Factors
Obesity, severe stress, thyroid disorders (especially hypothyroidism), diabetes, and certain medications can all contribute to excessive menstrual bleeding. That’s why a complete assessment of a patient’s general health is always part of the diagnostic process.
Identifying the cause requires a detailed medical history, a gynaecological examination, and laboratory and imaging tests. Only then effective and safe treatment can be selected.
Diagnostic Tests for Heavy Periods
The diagnosis of heavy menstrual bleeding focuses on identifying the cause and assessing its impact on the body. It begins with a detailed medical history and gynaecological examination, followed by laboratory and imaging tests where necessary.
1. Medical History and Gynaecological Examination
Your gynaecologist will ask about the length and heaviness of your periods, the presence of clots, and any accompanying symptoms such as pain, fatigue, or paleness. You will also be asked about your contraception methods, previous pregnancies, chronic illnesses, and medications. The physical examination helps assess the size and shape of the uterus, detect abnormalities such as fibroids or polyps and evaluate the cervix.
2. Laboratory Tests
- Full blood count (FBC) – to detect anaemia.
- Ferritin and iron levels – to confirm or rule out iron deficiency.
- Thyroid function (TSH) and reproductive hormones (FSH, LH, oestradiol, progesterone) – to assess hormonal balance, especially with irregular periods.
- Coagulation tests (PT, APTT, INR) – with suspected blood clotting disorder.
3. Imaging Tests
The primary imaging method is transvaginal ultrasound, which provides detailed information about the uterus, endometrium, and ovaries, helping detect fibroids, polyps, or other changes. In some cases, hysteroscopy – an endoscopic examination of the uterine cavity – may be recommended, especially when abnormal intrauterine structures or intermenstrual bleeding are suspected.
4. Additional Investigations
Depending on the findings, your gynaecologist may also recommend:
- Cervical smear test or colposcopy – with suspected cervical lesions.
- Endometrial biopsy – especially in women over 40 or when endometrial hyperplasia is suspected.
- Hormonal testing – including adrenal and thyroid function.
- Pregnancy testing – in unclear cases of uterine bleeding.
Treatment Options for Heavy Periods
The choice of treatment depends on the cause, severity of symptoms, patient’s age, and reproductive plans. The main goals are to reduce blood loss, improve quality of life, and prevent complications such as anaemia.
1. Medical Treatment
If there are no structural abnormalities, treatment usually begins with medication, including:
- Hormonal contraception – combined oral contraceptives or progestogen-only therapy to regulate cycles and reduce bleeding.
- Antifibrinolytic agents – such as tranexamic acid, taken during menstruation to reduce blood loss.
- Non-steroid anti-inflammatory drugs (NSAIDs) – which can lessen both bleeding and pain.
- Iron supplements – to treat or prevent anaemia caused by chronic blood loss.
2. Surgical Treatments
If heavy bleeding is caused by structural abnormalities or does not respond to medical therapy, surgical treatment may be recommended:
- Removal of polyps or fibroids – via hysteroscopy or other surgical techniques, depending on size and location.
- Endometrial ablation – a minimally invasive procedure that destroys the uterine lining, suitable for women who no longer wish to have children.
- Hysterectomy – surgical removal of the uterus, considered only as a last resort in severe, treatment-resistant cases.
3. Hormonal Intrauterine System (IUS)
A levonorgestrel-releasing intrauterine system (e.g. Mirena®) is an effective treatment for heavy periods. The hormone acts locally, thinning the endometrium and significantly reducing bleeding while also providing reliable contraception.
4. Lifestyle Change and Supportive Measures
Although not a standalone treatment, a balanced diet, regular physical activity, and maintaining a healthy weight can support hormonal balance and overall wellbeing. In women with obesity or metabolic syndrome, lifestyle modification can be an important complementary step in therapy.
Are Heavy Periods Common?
Yes, heavy periods (menorrhagia) are a relatively common gynaecological issue. It is estimated that they affect up to 20–30% of women of reproductive age, although the actual number may be higher – many women delay seeking help, assuming that heavier bleeding is simply normal for them.The problem appears more often during the perimenopausal period and among younger women with irregular or unstable cycles. Heavy menstrual bleeding can also be an early symptom of conditions such as uterine fibroids, endometriosis, hormonal imbalances, or blood disorders.
Bleeding Between Periods vs. Menorrhagia – How to Tell the Difference
Both heavy periods and intermenstrual bleeding may indicate problems within the reproductive system, but they are two separate symptoms requiring different diagnostic and therapeutic approaches.
Menorrhagia, or excessive menstrual bleeding, refers to regular, cyclical periods that:
- last longer than 7 days,
- require frequent changing of pads or tampons,
- involve significant blood loss (over 80 ml per cycle),
- may contain clots and trigger symptoms of anaemia (such as weakness, paleness, or dizziness).
Intermenstrual bleeding (metrorrhagia), on the other hand, is any vaginal bleeding that occurs between regular periods, regardless of the cycle phase. It may appear as:
- light spotting,
- bleeding lasting several hours or days,
- unpredictable bleeding of varying intensity.
Typical causes of bleeding between periods include:
- hormonal imbalances (e.g. progesterone deficiency),
- endometrial or cervical polyps,
- cervical erosion or other cervical lesions,
- side effects of hormonal contraception,
- gynaecological infections,
- and less commonly, precancerous or cancerous changes.
Distinguishing between these two types of bleeding is crucial, as each carries a different risk profile and requires specific evaluation. Regular cycle monitoring, keeping a menstrual diary, and seeking medical advice promptly can help establish an accurate diagnosis and ensure effective treatment.
Heavy Periods in Teenagers
Irregular or heavy periods are common during puberty and are usually part of the natural process of hormonal maturation, which stabilises within one to two years after menarche (the first period). However, if bleeding is excessive, it should be evaluated by a gynaecologist to rule out underlying disorders.
In adolescents, cycles are often anovulatory — oestrogen levels rise, but there is insufficient progesterone to counteract its effect, resulting in overgrowth of the uterine lining and heavy bleeding when it sheds.
Symptoms that require medical attention:
- Periods lasting more than seven days.
- The need to change pads or tampons every one to two hours.
- Presence of large clots.
- Weakness, dizziness, or difficulty functioning during menstruation.
- No improvement after several cycles from the first period.
In teenagers, heavy periods may also be linked to bleeding disorders (e.g. von Willebrand disease), thyroid problems, or eating disorders. Diagnostic tests should include hormonal assessment and basic blood work, including clotting parameters and TSH.
A visit to a paediatric or adolescent gynaecologist allows for early diagnosis and gentle, age-appropriate treatment – hormonal or symptomatic. Education about menstrual health and what constitutes a normal period is also an essential part of care for young patients.
How Heavy Periods Affect Quality of Life
Heavy periods can significantly affect a woman’s physical and emotional wellbeing. Many patients experience chronic fatigue, discomfort, and disruption to daily activities. In severe cases, heavy bleeding can interfere with work, education, and social life.
Physical effects include fatigue, headaches, dizziness, and concentration difficulties, often caused by iron deficiency. Persistent bleeding can make recovery slower and affect overall vitality.
Emotional and social aspects are equally important. Many women report anxiety about leakage, odour, or the need for frequent changes of sanitary products. Some avoid exercise, travel, or social activities during their period, leading to frustration or low mood. In younger girls, this may even result in school absences or withdrawal from social interactions.
Summary
Heavy periods are not just an inconvenience – they can be a sign of hormonal imbalance, uterine abnormalities, or other medical conditions that require treatment. Prolonged bleeding, large clots, shortened cycles, or symptoms of anaemia are clear reasons to see a gynaecologist.>
At our clinic in Harrow, London, our specialists provide full diagnostic and treatment options for menstrual disorders, including laboratory tests, transvaginal ultrasound, and personalised therapy plans.
We offer consultations in Polish and English, ensuring comfortable, clear communication and culturally sensitive care for every patient.
