What counts as heavy menstrual bleeding?
Heavy menstrual bleeding is unusually heavy flow, bleeding lasting more than seven days, or bleeding that substantially interferes with daily life. Practical signs include changing a saturated pad or tampon every hour, needing double protection, waking repeatedly at night, passing large clots, or frequently bleeding through clothing.
Ongoing blood loss can cause iron-deficiency anaemia. Fatigue, pallor, shortness of breath, palpitations, dizziness, and headaches can be warning symptoms.
What causes heavy periods?
- Ovulatory dysfunction, PCOS, thyroid disease, or perimenopause;
- Uterine fibroids, polyps, or adenomyosis;
- Pregnancy-related bleeding, including early pregnancy loss;
- A bleeding disorder;
- A copper intrauterine device or certain medicines;
- Less commonly, precancerous or cancerous endometrial change.
The likely causes vary with age and medical history, so treatment should follow diagnosis.
When is bleeding an emergency?
If you are soaking one or more pads/tampons every hour for more than two hours and also have dizziness, shortness of breath, chest pain, faintness, or marked weakness, seek emergency care. Urgent assessment is also needed with possible pregnancy, severe pelvic pain, fever, or any bleeding after menopause.
How is the cause investigated?
Your clinician will review cycle timing, bleeding amount, pregnancy possibility, medicines, and family history. Common tests include a full blood count and ferritin, a pregnancy test, and selected hormone or clotting tests.
Pelvic ultrasound assesses uterine size and muscle, the endometrium, fibroids, possible polyps, and the ovaries. Depending on age and symptoms, hysteroscopy, sonohysterography, or endometrial biopsy may also be needed.
What treatments are available?
Management depends on the cause, severity, age, other health conditions, and future pregnancy plans. Options may include iron, non-steroidal anti-inflammatory medication, tranexamic acid, hormonal contraception, or a hormonal intrauterine system. A structural cause may require a procedure or surgery.
Do not self-start tranexamic acid, hormones, or pain medication: each has contraindications and must be appropriate for your health profile.
How should you prepare for the appointment?
- Record the first and last day of each period;
- Estimate pads/tampons used and the presence of clots;
- Note bleeding between periods or after sex;
- Bring a medication list, blood results, and previous imaging.
Why book imaging with Lana Ezieshvili?
Detailed pelvic imaging can directly influence the next step in management. Radiologist Lana Ezieshvili assesses the uterus, endometrium, and ovaries and clearly documents any structural changes.
If heavy periods recur or your gynaecologist requests imaging, book a pelvic ultrasound with Lana Ezieshvili. For related concerns, read Late periods and menstrual cycle disorders.