Heavy Periods — When to See a Specialist

Heavy periods — known medically as menorrhagia — are one of the most common gynaecological complaints in the UK, yet many women endure significant disruption to their daily lives before seeking specialist help. Heavy periods are not something you simply have to put up with. In most cases, there is an identifiable cause and an effective treatment. At AristoGP, our consultant gynaecologist provides a thorough assessment, including same-day pelvic ultrasound, to investigate the cause and guide management.

What Are Heavy Periods?

Clinically, heavy menstrual bleeding (menorrhagia) is defined as blood loss of more than 80ml per menstrual cycle. In practice, measuring blood loss is not straightforward, and the diagnosis is typically based on the impact on daily life and on certain practical indicators. You may be experiencing heavy periods if one or more of the following apply:

• Your period lasts longer than seven days
• You need to change a pad or tampon every one to two hours, or more frequently
• You regularly pass blood clots larger than 2.5cm (approximately the size of a 50p coin)
• You bleed through your clothing or bedding despite using sanitary protection
• You need to use double protection (for example, both a tampon and a pad simultaneously)
• You feel unable to leave the house or carry out normal activities during your period
• You experience symptoms of anaemia — tiredness, breathlessness, or heart palpitations — which may result from significant regular blood loss

Heavy periods are extremely common — they affect up to one in three women at some point during their reproductive years. But common does not mean normal or inevitable. Effective treatment is available, and the first step is understanding what is causing your bleeding.

Common Causes of Heavy Periods

Heavy menstrual bleeding can result from a range of gynaecological and systemic causes. In many cases, more than one contributing factor may be present. Common causes include:

• Uterine fibroids — Benign growths in or on the uterus that can distort the uterine cavity and significantly increase menstrual flow. See our fibroids assessment page for more information.
• Uterine polyps — Small, usually benign growths that develop from the lining of the uterus or cervix and can cause heavy or irregular bleeding.
• Adenomyosis — A condition in which the tissue that normally lines the uterus grows into the muscle wall of the uterus. This can cause heavy, painful periods and an enlarged, tender uterus.
• Hormonal imbalances — Imbalances in oestrogen and progesterone can prevent the uterine lining from shedding in the normal controlled manner, leading to heavier bleeding.
• Endometriosis — A condition in which tissue similar to the uterine lining grows outside the uterus, which can contribute to heavy and painful periods. See our endometriosis page.
• Polycystic ovary syndrome (PCOS) — Can cause irregular and sometimes heavy periods due to infrequent ovulation. Our PCOS specialist can provide a full assessment.
• Thyroid disorders — Both an underactive (hypothyroidism) and overactive (hyperthyroidism) thyroid can affect the menstrual cycle.
• Bleeding disorders — Conditions affecting blood clotting, such as von Willebrand disease, can cause heavy periods. These are more often identified in younger women with a history of heavy periods from the outset.
• Intrauterine device (IUD) — The copper IUD (non-hormonal coil) is a common cause of heavier periods in women who use it as contraception.
• Perimenopause — The transitional period before the menopause is often associated with changes in the menstrual pattern, including heavier or more erratic bleeding.
• No identifiable structural cause (dysfunctional uterine bleeding) — In a proportion of cases, no structural or systemic abnormality is found and the diagnosis is idiopathic (or dysfunctional) uterine bleeding.

When Should You Seek Help?

You should seek specialist assessment if any of the following apply to you:

• Heavy periods are interfering with your work, social life, or daily activities
• You are experiencing symptoms consistent with anaemia — persistent fatigue, breathlessness, pallor, or heart palpitations
• Your periods have recently become significantly heavier or longer than usual
• You are passing large clots or experiencing flooding
• You are experiencing bleeding between periods or after intercourse (postcoital bleeding)
• You have had a postmenopausal bleed (any bleeding that occurs 12 or more months after your last period should always be investigated promptly)
• You have concerns about the cause of your bleeding and would like clarity and reassurance

Heavy Periods Assessment at AristoGP

A thorough assessment for heavy periods requires both a careful clinical history and appropriate investigations. At AristoGP, our consultant-led gynaecology assessment is carried out by Dr Anastasia Mermigka (GMC 7640566) and includes:

• Detailed menstrual history — Including the timing, duration, and severity of bleeding; any associated pain; pattern of bleeding; and any relevant changes
• Full gynaecological and medical history — Including contraception, previous gynaecological investigations, family history, and any systemic conditions
• Pelvic examination on a dedicated gynaecology examination plinth, assessing for uterine size, tenderness, and any palpable masses
• Same-day pelvic ultrasound — Using high-resolution specialist equipment to assess the uterus and ovaries. This can identify fibroids, polyps, adenomyosis, and endometriomas, and allows measurement of endometrial thickness
• Blood test recommendations — Including full blood count (to check for anaemia), thyroid function, and coagulation tests if a bleeding disorder is suspected. Blood tests can be arranged directly from the clinic

Because the same consultant who takes your history also performs the pelvic examination and the ultrasound, findings are interpreted together in real time. This integrated, consultant-performed ultrasound approach provides a more complete assessment than a pathway where the scan and the clinical consultation are separated.

Treatment Options for Heavy Periods

Treatment will depend on the underlying cause, the severity of your symptoms, your age, and your reproductive wishes. Options include:

Non-Hormonal Medical Treatment

Tranexamic acid reduces blood loss by preventing blood clots from breaking down too quickly; it is taken during the period and can reduce blood loss by up to 50%. Non-steroidal anti-inflammatory drugs (NSAIDs) such as mefenamic acid reduce both bleeding and menstrual pain. Both can be used without affecting future fertility.

Hormonal Treatments

The combined oral contraceptive pill regulates the menstrual cycle and typically reduces blood loss significantly. Progestogen-only treatments — including the Mirena intrauterine system (hormonal coil), Depo-Provera injection, or oral progestogen — can markedly reduce or eliminate menstrual bleeding. The Mirena coil is one of the most effective treatments for heavy periods and is appropriate for many women regardless of whether they need contraception.

Surgical Options

Where medical management is insufficient, surgical options may be considered. Endometrial ablation destroys the lining of the uterus and can significantly reduce or eliminate periods in suitable candidates. Myomectomy or hysteroscopic polypectomy may be appropriate where fibroids or polyps are the cause. Hysterectomy is the definitive treatment for heavy periods in women who have completed their family and in whom other treatments have not been effective. Where surgical referral is indicated, AristoGP will arrange this to an appropriate specialist.

A Well Woman Check at AristoGP provides a broader assessment of gynaecological health and is particularly recommended if you have not had a recent cervical smear or wish to include screening alongside your menstrual health assessment.

Heavy Periods Assessment: Pricing

For most women attending for heavy period assessment, the Consultation + Pelvic Ultrasound package (£250) is the most complete starting point. Visit our contact page with any pricing questions.

Frequently Asked Questions — Heavy Periods

This page has been reviewed and approved by Dr Anastasia Mermigka, Consultant Gynaecologist, GMC 7640566. Dr Mermigka holds subspecialty training in reproductive medicine and provides consultant-led gynaecology services at AristoGP, Central London EC1.