Heavy menstrual bleeding (menorrhagia) is when periods are abnormally heavy or prolonged, interfering with daily life. It affects 1 in 5 women and can lead to fatigue, anaemia, or emotional distress.
Common symptoms
- Soaking through a pad/tampon every 1–2 hours.
- Passing blood clots larger than a quarter.
- Periods lasting longer than 7 days.
- Fatigue or shortness of breath (signs of anaemia).
- Avoiding activities due to heavy flow.
Possible causes
- Hormonal imbalances (e.g., thyroid disorders, PCOS).
- Uterine fibroids or polyps (non-cancerous growths).
- Bleeding disorders (e.g., von Willebrand disease).
- Medications (e.g., blood thinners, IUDs).
- Miscarriage or ectopic pregnancy (if sudden heavy bleeding).
- Endometriosis or adenomyosis.
Diagnosis:
- History: Track symptoms using a menstrual calendar and prepare 3-6 months menstrual diary for gynaecological consultation.
- Tests:
Blood tests (check for anaemia, thyroid issues, clotting disorders).
Pelvic ultrasound (look for fibroids, polyps, adenomyosis or endometriosis).
Biopsy (rule out endometrial cancer in high-risk patients).
Treatment options
Medical Treatments
- Tranexamic acid: Reduces bleeding by 30–50% (taken during periods).
- NSAIDs (e.g., ibuprofen): Eases cramps and reduces flow.
- Hormonal therapies:
- Birth control pills, patches, or hormonal IUDs (e.g., Mirena).
- Progesterone tablets to regulate cycles.
- Iron supplements: For anaemia.
Surgical options
- Endometrial ablation: Thins the uterine lining (not ideal if planning future pregnancy).
- Myomectomy: Removes fibroids but preserves uterus.
- Hysterectomy: Removes the uterus (last resort for severe cases).
eGynaecologist Advice
- You must seek urgent gynaecological care if bleeding soaks through 2 pads/hour for 2+ hours or if you feel dizzy, faint, or have chest pain.
- Heavy periods are common but treatable, and you should consult your gynaecologist if heavy bleeding disrupts work, school, or social life.
- You must consult gynaecologist if bleeding continues after menopause as this may indicate endometrial cancer (1 in 10 women with post-menopausal bleeding).
Frequently Asked Questions
Is heavy bleeding normal?
No – seek evaluation if you’re changing pads/tampons hourly or passing large clots.
Can this affect fertility?
Depending on the cause (e.g., fibroids), yes. Early treatment improves outcomes.
Do I need treatment if I’m not anaemic?
Yes! Heavy bleeding impacts quality of life, even without anaemia.
Is this linked to menopause?
Heavy bleeding near menopause may signal hormonal changes or other conditions.
How can I stop the bleeding now?
Tranexamic acid or NSAIDs can reduce flow quickly. Ask your doctor.
