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Heavy periods (menorrhagia)

Published by Bupa's health information team, November 2009.

This factsheet is for women who have heavy periods (menorrhagia), or anyone who would like information about it.

Menorrhagia is very common. In the UK, around one in three women describe their periods as heavy. It can affect any woman who has periods, although it usually affects women over the age of 30.

About menorrhagia
Symptoms of menorrhagia
Complications of menorrhagia
Causes of menorrhagia
Diagnosis of menorrhagia
Treatment of menorrhagia
Questions and answers
Related topics
Further information
Sources

About menorrhagia

During your period, you will probably lose between 30 and 40ml of blood. However, some women can lose up to 80ml of blood or more. This is defined as a heavy period. However, it's very difficult to measure the amount of blood lost during a period so doctors describe menorrhagia as several regular heavy periods that affect you physically and emotionally.

The following signs may indicate that you have menorrhagia.

You need to change your sanitary towel every two hours or more frequently.
You need to use double sanitary protection (tampons and towels).
You pass large blood clots.
You bleed through to your clothes or bedding (sometimes called 'flooding').
Your periods affect your normal activities like going out, working, shopping or sex.

Symptoms of menorrhagia

As well as heavy bleeding, you may have the following symptoms:

longer periods than normal
tiredness
light-headedness
poor sleep pattern
shortness of breath

These symptoms aren't always caused by menorrhagia but if you have them, you should visit your GP.

Complications of menorrhagia

Menorrhagia can cause iron deficiency and anaemia. Anaemia is a condition where you have too few red blood cells or not enough haemoglobin in your blood. Around two-thirds of women with menorrhagia have iron-deficiency anaemia.

Menorrhagia can make you feel self-conscious and embarrassed during your period. It may also cause you to have mood swings or affect your sex life.

Causes of menorrhagia

The exact reasons why you may develop menorrhagia aren't fully understood at present. Doctors aren't able to find a cause for menorrhagia in four to six out of ten women who have it. This is called dysfunctional uterine bleeding (unexplained menorrhagia).

However, menorrhagia can be caused by:

fibroids
polyps in your womb
endometriosis
pelvic inflammatory disease
polycystic ovarian syndrome (PCOS)
blood disorders
conventional intrauterine contraceptive devices (IUCDs)
womb cancer, although this is rare in younger women

In some cases, menorrhagia can also be caused by an underactive thyroid.

Diagnosis of menorrhagia

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history and take a blood sample to check for iron-deficiency anaemia. If your GP suspects that your menorrhagia is caused by an underactive thyroid, your blood will also be tested for this.

Your GP may refer you to a gynaecologist - a doctor specialising in women's reproductive health - for further investigation and treatment. He or she may recommend that you have an ultrasound or a biopsy. Whether you have these tests will depend on the potential cause of your menorrhagia.

Treatment of menorrhagia

Your treatment will vary depending on whether a cause can be found for your menorrhagia, and if so, what this is.

If no cause for your menorrhagia is found, there are various treatments that aim to reduce the heavy bleeding and prevent iron-deficiency anaemia from developing.

Medicines

If you're not trying to get pregnant, your GP may recommend you get a levonorgestrel-releasing intra-uterine system (IUS) fitted (Mirena®). Your GP will only recommend this if you're happy to have it fitted for at least a year. The IUS lasts up to five years and should help to improve your menorrhagia within the first three to six months. If your symptoms don't improve in this time, speak to your GP.

If the IUS isn't suitable for you, your GP may recommend you try:

tranexamic acid
non-steroidal anti-inflammatory medicines (NSAIDs)
combined oral-contraceptive pill

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Non-surgical treatments

Uterine artery embolisation

A uterine artery embolisation, or fibroid embolisation, is a type of non-surgical treatment for fibroids. However, it can also be used to treat menorrhagia if you also have large fibroids that are causing bleeding. The arteries which supply your fibroids with blood are called uterine arteries. A uterine artery embolisation blocks off these uterine arteries, causing your fibroids to shrink.

Surgery

Endometrial ablation

Endometrial ablation is a surgical treatment where most of your womb lining is destroyed or removed using energy such as microwaves or heat. It's not usually recommended if you have growths in your womb (fibroids) or if you want to have children in the future.

Hysterectomy

A hysterectomy is an operation to remove your womb. It's is usually only done if other treatments haven't worked. After a hysterectomy, you will no longer have periods and won't be able to become pregnant.