Heavy periods

Also called Menorrhagia, Heavy menstrual bleeding

Around 1 in 3 women describe their periods as heavy. Most put up with it, and many are anaemic because of it.

What it is

Heavy menstrual bleeding affects around a third of women, and NICE defines it in the way that actually matters: bleeding that interferes with physical, social, emotional or material quality of life. Not a volume in millilitres.

That definition exists because women were routinely told their periods were within normal limits while being unable to leave the house.

Causes include fibroids, adenomyosis, endometriosis, polyps, hypothyroidism, bleeding disorders, and in many cases nothing identifiable.

The consequence most often missed is iron deficiency anaemia. Women are treated with iron for years without anybody addressing why they are losing it.

Signs you might notice

Needing to change protection every hour or two, or using two types together.

Flooding through clothes or bedding.

Passing clots larger than a 10p piece.

Periods lasting more than seven days.

Planning life around periods: taking days off, avoiding travel, staying home.

Tiredness, breathlessness and pallor, from anaemia.

Bleeding between periods, after sex, or after the menopause is different and always needs investigating.

How it can affect day-to-day life

The normalisation is the problem. Girls and women are told periods are meant to be difficult, so they do not raise it, and many do not know that other people's experience differs from theirs.

Anaemia builds slowly, so the fatigue is attributed to work, parenting or age.

The workplace and school cost is substantial and invisible.

Treatment options are good and under-offered: the hormonal coil is first-line in NICE guidance and is highly effective, tranexamic acid works well for those who prefer non-hormonal treatment, and surgical options exist.

Supporting someone well

Describe the impact rather than the volume. "I cannot leave the house on day two" gets a better response than "they are quite heavy".

Ask for a full blood count and ferritin. Treat the anaemia and find the cause.

Ask about the hormonal coil specifically; it is the first-line treatment in the guidance and many people are never told.

Ask about tranexamic acid for non-hormonal treatment; it reduces bleeding substantially and is taken only during periods.

Get bleeding between periods, after sex, or after the menopause investigated separately and urgently.

For a young person, ask about a bleeding disorder if periods have been heavy since they started.

Where to get help

A GP should assess, test for anaemia, and offer treatment without requiring an ultrasound first in most cases.

The Royal College of Obstetricians and Gynaecologists publish patient information on the options.

Post-menopausal bleeding needs an urgent two-week wait referral.