Heavy periods (heavy menstrual bleeding)

Heavy menstrual bleeding means periods heavy enough to interfere with physical, social or emotional quality of life — for example flooding, passing large clots, needing to change protection hourly, or bleeding for more than about a week. It is defined by impact, not by measuring millilitres. The commonest consequence, and often the first clue, is iron-deficiency anaemia from the repeated blood loss. The causes fall into: structural problems of the womb (fibroids, polyps, adenomyosis); hormonal imbalance (anovulatory cycles as in PCOS, thyroid disease, perimenopause); bleeding or clotting disorders (which may show up first as heavy periods, especially since adolescence); the copper coil; and, less commonly, pre-cancerous or cancerous changes of the womb lining, which is why persistent or new heavy bleeding — especially after 45 or between periods — is investigated.

• Fibroids and polyps — very common structural causes.
• Hormonal / anovulatory cycles — PCOS, thyroid disease, perimenopause.
• Adenomyosis — womb-lining tissue within the muscle; heavy, painful periods.
• Bleeding disorders — e.g. von Willebrand disease; suspect if heavy since periods began.
• Copper intrauterine device (IUD).
• Thyroid disease — both under- and over-active can disrupt bleeding.
• Endometrial hyperplasia or cancer — uncommon but important, especially over 45 or with bleeding between periods.

The essential blood tests are a full blood count and ferritin, because iron-deficiency anaemia from heavy periods is common and treatable and often the reason to act. TSH screens for thyroid disease. If bleeding has been heavy since periods first started, or there are other bleeding symptoms, coagulation and von Willebrand testing are considered. Hormone tests (including for PCOS) are guided by the cycle pattern. Beyond blood work, a pelvic ultrasound looks for fibroids and polyps, and an endometrial biopsy is considered for women over 45, or with bleeding between periods or risk factors, to exclude pre-cancer. Mediora.AI surfaces the haemoglobin, ferritin and thyroid pattern; the gynaecological assessment and any imaging belong with your doctor.