Gynaecology · 5 min read · June 2026
Heavy periods: when to investigate rather than wait
Women are told to tolerate heavy bleeding far too often. Heavy menstrual bleeding is defined by its effect on you, not by a measured volume — and it is a symptom with a cause, which is worth finding.
What counts as heavy
Soaking a pad or tampon every hour for several hours, passing clots larger than a rupee coin, bleeding beyond seven days, or having to plan your day around the bleeding. Tiredness and breathlessness usually mean the haemoglobin has fallen, and that is checked at the same visit.
The common causes
Fibroids, adenomyosis, endometrial polyps, thyroid disease, clotting disorders and, less often, endometrial pathology. An ultrasound and a haemoglobin answer most of the question; endometrial sampling is added where the age or the findings require it.
Treatment in order
Correct the anaemia, then treat the cause. Medical management — tranexamic acid, hormonal treatment or a hormone-releasing device — is tried first where it is appropriate. Surgery is for when medical treatment fails or is unsuitable, not as the opening move.
The bleeding that is never normal
Bleeding after intercourse, between periods, or any bleeding a year or more after periods have stopped. These are investigated, not managed with tablets.
When to come in
- Soaking a pad an hour, or clots for more than a day
- Bleeding between periods or after intercourse
- Any bleeding after menopause