Heavy periods and menstrual health explained

What counts as heavy bleeding

Rather than measuring blood loss, the NHS defines heavy menstrual bleeding by its impact on your life. Signs that periods are heavy include soaking through pads or tampons every hour or two, needing to use two types of protection together, bleeding through to clothes or bedding, passing large clots, or having to plan daily activities around your period. Periods that regularly last more than seven days also count. Very heavy or prolonged bleeding can drain the body's iron and cause anaemia, with symptoms of tiredness, breathlessness and looking pale. Importantly, what matters is whether the bleeding is a problem for you — there is no need to justify it against anyone else's experience.

Common causes

Often no specific cause is found, and the periods are simply heavy — this is common and still treatable. When there is a cause, fibroids (non-cancerous growths in the womb muscle) and polyps (small growths in the womb lining) are frequent culprits. Adenomyosis, where womb-lining tissue grows into the muscle wall, can cause heavy, painful periods. Hormonal changes, including around the perimenopause, and conditions like polycystic ovary syndrome can affect bleeding. Less commonly, bleeding or clotting disorders, thyroid problems, or certain contraceptive devices play a role. Very occasionally, heavy or irregular bleeding can be a sign of changes in the womb lining that need checking, which is why persistent symptoms should be assessed rather than ignored.

When to see your GP

It is worth seeing your GP if heavy periods are affecting your quality of life, if you feel constantly tired or breathless, or if the pattern of your bleeding changes. Some symptoms need prompt assessment: bleeding between periods, bleeding after sex, any bleeding after the menopause, or periods that suddenly become much heavier or more painful. Your GP will ask about your bleeding, your general and reproductive health, and may examine you and arrange blood tests, including checking for anaemia. Depending on the picture, they may recommend an ultrasound scan of the womb or, sometimes, a sample of the womb lining. This assessment guides which treatments are suitable for you.

Treatment options

Treatment is tailored to the cause, your preferences and whether you want contraception or are trying to conceive. NICE often suggests a hormonal intrauterine system — a small device placed in the womb — as a first option for many people, as it substantially reduces bleeding over time. Other medicines can reduce blood loss during periods, some taken only on bleeding days, and hormonal options like the combined pill can help regulate cycles. If medicines are not suitable or do not work, procedures such as removing polyps, treating fibroids, or an endometrial ablation (which thins the womb lining) may be offered, and hysterectomy is a definitive option in selected cases. Treating anaemia and boosting iron is important alongside.

Looking after your menstrual health

Beyond specific treatments, understanding your own cycle is powerful. Tracking your periods — their length, heaviness, pain and any bleeding in between — gives your GP valuable information and helps you notice changes early. If heavy bleeding is leaving you drained, eating iron-rich foods and following any iron treatment your clinician recommends can help restore energy. Heavy periods are common but not something you simply have to endure; effective options exist and seeking help is worthwhile. Menstrual health is a normal part of overall health, and persistent pain, flooding or exhaustion always deserve attention rather than being dismissed as "just part of being a woman".