Heavy periods (menorrhagia)

What is a heavy period?

A heavy period is when your period lasts longer than eight days or you lose more than 80 mL of blood each period. It’s a common problem for people aged between 30 and 50.

The amount of blood loss can change at different life stages. For example, in teenage years or in the lead-up to menopause.

Watch this video about heavy periods.

How do you know if you have heavy periods?

It can be hard to tell if you have heavy periods, but there are some common signs. For example:

• you need to change your period product (e.g. pads, tampons, menstrual cup) every two hours or less
• you need to change your period product overnight
• you notice blood clots that are bigger than a 50-cent coin
• your period lasts more than eight days
• your periods stop you from doing things you normally do.

Some period products hold more blood than others, so tell your doctor about the type of period products you use to help them understand if your periods are heavy.

Symptoms of heavy periods

If you have heavy periods, you might:

• have cramps or pain in your lower belly (abdomen)
• look pale or feel tired or dizzy due to low iron levels.

What causes heavy periods?

Heavy periods may be due to hormonal changes that make your uterus lining grow more than usual. This lining sheds to create a period. But there may be other causes, for example:

• endometriosis
• endometrial polyps
• endometrial hyperplasia
• fibroids
• adenomyosis.

Polycystic ovary syndrome (PCOS) mostly causes irregular periods, but if the lining of the uterus becomes thickened it can cause heavy periods too.

How are heavy periods diagnosed?

It’s important to see your doctor if you have heavy periods and symptoms are affecting your daily life.

You can record information about your periods and take it with you to discuss at your appointment. For example, when you get your period, the length and heaviness of your period and how your periods impact your life.

Your doctor will ask about your medical history and may ask to do an internal examination to check your uterus and ovaries.

They might do tests to find out what’s causing the problem. For example, a pregnancy, iron or blood test.

Your doctor may also organise an ultrasound to check your pelvic organs. This can be done on your abdomen or inside your vagina. You can tell your doctor if you’re not comfortable having an internal ultrasound.

They will contact you to discuss any test results and next steps.

Treatment options

If you are diagnosed with heavy periods, your doctor will discuss different treatment options.

They may recommend:

• certain medicines (e.g. anti-inflammatory drugs or tranexamic acid)
• hormonal treatments (e.g. a Mirena® intrauterine device (IUD) or the Pill)
• progestins (synthetic forms of the progesterone hormone).

Your doctor may also refer you to a specialist (e.g. a gynaecologist) to do more tests.

Treatment for low iron levels

It’s important to get your iron levels checked and treated if they are low. Your doctor may recommend you take a daily iron supplement or have an iron infusion.

Surgery

If medicines don’t reduce your bleeding, your doctor might refer you to a gynaecologist to discuss other options such as surgery.

Depending on the cause of your bleeding, you might need to have:

• a hysteroscopy – a day procedure to assess the inside of your uterus and remove fibroids or polyps if required
• an endometrial ablation – a day procedure to remove the lining of the uterus (not recommended if you want to have children in the future).

In some cases, when medical or other surgical procedures haven’t helped to manage bleeding, you may need to have a hysterectomy (an irreversible operation to remove the uterus and often the fallopian tubes).

It’s important to discuss the risks and benefits of each procedure with your gynaecologist before you decide.

Listen to this podcast about how heavy periods can affect you.