Heavy periods

Heavy menstrual bleeding is also known as menorrhagia. It's excessive blood loss that interferes with your:

• physical health
• social life
• emotional wellbeing

Your periods may be considered heavy if you:

• bleed for more than 8 days
• lose more than 80 mL of blood during a period

Heavy periods are a common problem. About 1 in 4 females experience heavy periods.

A period is heavy if you:

• pass blood clots larger than a 50 cent coin during your period
• need to change your tampon or pad every 1 to 2 hours
• need to change your tampon or pad overnight
• have to use a towel on your bed or a maternity pad when you sleep
• bleed through clothing
• bleed for more than 8 days
• are not able to do things you normally would during your period

If you have heavy periods, you might also:

• feel very tired
• look pale
• have cramps or pain in your lower abdomen (tummy)
• be short of breath

There are various causes of heavy periods, including:

• hormone imbalance
• changes in your uterus
• blood clotting disorders

Hormone imbalance

Hormone imbalance is when the hormones that control your menstrual cycle are not working normally. A hormone imbalance can be due to:

• polycystic ovarian syndrome (PCOS) — a common hormonal condition that affects your ovaries
• hypothyroidism — underactive thyroid
• starting or changing hormone based medicines, such as birth control
• perimenopause — the stage of life leading up to your last period
• puberty — when your hormones are changing and you first start getting your period.

A hormone imbalance may cause an anovulatory cycle. This is where an egg is not released from your ovary during your menstrual cycle. Anovulatory cycles may cause symptoms including heavy periods in teenagers and adolescents.

Changes in your uterus

When there is a problem with the structure or lining of your uterus, this can affect how the lining grows or sheds during your period.

Heavy periods due to changes in your uterus may be caused by:

• fibroids — non-cancerous growths in the muscle layer of your uterus
• uterine polyps — non-cancerous growths in the lining of your uterus
• endometrial hyperplasia — when the lining of your uterus becomes too thick
• endometrial cancer — cancer of the lining of your uterus
• adenomyosis — when extra cells grow in the muscle layer of your uterus
• endometriosis — when tissue like the lining of your uterus grows in other parts of your body

Blood clotting disorders

Blood disorders include conditions when your blood does not clot properly. This can make bleeding during your period heavier or last longer.

Heavy periods due to blood disorders may be caused by:

• von Willebrand disease — an inherited condition where blood takes longer to clot
• platelet function disorder — when the cells that help your blood clot do not work properly
• thrombocytopenia — low levels of platelets in your blood

Some medicines, such as blood thinners, can also cause heavy periods.

For many females with heavy periods, the cause is not known.

To diagnose heavy periods, your doctor will ask you about your:

• symptoms
• general health
• medical history
• sexual history

They may also examine you and arrange for tests such as:

• a sexually transmitted infection (STI) test
• a blood test
• a urine test
• an ultrasound scan

An ultrasound can be done on your abdomen or inside your vagina. Tell your doctor if you're not comfortable having an internal ultrasound.

Your doctor may refer you to a gynaecologist for further testing and treatment. A gynaecologist is a specialist doctor who manages conditions that affect the female reproductive system.

It's a good idea to keep a record about your period using a diary or phone app. For example, make a note of:

• when you get your period
• how long your period lasts
• how heavy your period is
• when your period stops

Take this record to your appointment to discuss with your doctor.

Your doctor should do their best to listen to you and take your concerns seriously. If this doesn't happen, do not be afraid to find a new doctor.

See your doctor if:

• you have symptoms of heavy periods
• your periods affect your everyday life
• you experience bleeding after menopause
• you have spotting (bleeding between periods)
• you have bleeding after sex

When to seek urgent care

Seek care from an urgent care clinic if you have:

• a heavy period as well as symptoms of anaemia, such as dizziness or weakness
• bleeding that is suddenly much heavier than usual
• abnormal vaginal bleeding

If you have heavy or abnormal vaginal bleeding and you need urgent care, talk to a nurse or doctor at a Medicare Urgent Care Clinic or go to a hospital emergency department.

Treatment for heavy periods will depend on the cause. Your doctor will recommend the best option for you. This will depend on:

• your age
• your health
• your medical history
• whether you would like to be pregnant in the future
• how successful other treatments have been

Self-care at home

During your period, you may want to wear multiple forms of protection at the same time. This might include a tampon or menstrual cup as well as a pad or period underwear. This will give you some extra protection.

Consider putting together a period kit to keep at school or work. This can include:

• fresh underwear
• tampons, pads and period underwear
• a plastic bag
• a change of clothes

You can care for yourself at home by:

• eating a balanced diet
• reducing stress
• getting enough sleep
• exercising regularly
• maintaining a healthy bodyweight

Medicines and hormones for heavy periods

Medicines and hormones that can help treat heavy periods include:

• tranexamic acid — a medicine used to reduce bleeding
• non-steroidal anti-inflammatory drugs (NSAIDs)
• a hormone-releasing intrauterine device (IUD)
• the oral contraceptive pill ('the pill')
• the progestogen-only pill

Heavy periods can lead to iron deficiency. Your doctor may recommend iron supplements or an iron infusion if your iron levels are low.

Talk with your doctor about which medicines are right for you.

Other treatment options

If self-care and medicines do not improve your symptoms, heavy periods can sometimes be treated with surgery.

Surgical options include:

• a hysteroscopy
• endometrial ablation
• a hysterectomy

It's important to discuss the risks and benefits of each procedure with your doctor before you decide what to do.

Blood loss from heavy periods can lower your levels of iron and red blood cells. This can cause iron deficiency and anaemia.

Common symptoms of iron deficiency and anaemia are:

• tiredness
• dizziness when standing up
• shortness of breath
• palpitations
• pale skin

The Jean Hailes for Women's Health website offers information on:

• heavy periods
• irregular periods
• premenstrual syndrome (PMS)
• different types of period pain

The Royal Women's Hospital page has factsheets on:

• heavy periods
• what causes heavy periods
• healthy periods

Languages other than English

The Jean Hailes for Women's Health page has a short, animated video about periods and menopause available in multiple languages.