Note: This information is for cyclical heavy bleeding only, if you may be pregnant, have just given birth, or had abdominal surgery, are peri-menopausal, or do not have a menstrual cycle, please consult a doctor about any unusual bleeding.

Heavy menstrual bleeding (HMB)– The medical term is ‘menorrhagia‘-  This is quite a common problem (affecting up to 10% of the UK population), which can significantly affect quality of life. Sufferers may feel unable to leave the house for fear of bleeding through their clothes, or lack of access to toilets; they may feel tired, dizzy, physically weak, or find it difficult to concentrate. Heavy menstrual bleeding can lead to iron deficiency anaemia.

Notes: Technically ‘heavy bleeding’ refers to losing over 80ml of blood during the course of a period. The easiest way to measure menstrual blood loss is by using a cup, especially a clear one with measurement levels e.g. the Mooncup. Otherwise, you can estimate blood loss by counting how many tampons or pads you bleed through e.g. each soaked ‘super’ tampon or pad= approx. 10ml, each regular soaked tampon or pad = approx. 5ml. 

• Do you have to wear tampons and towels together?
• Do you have to change protection more than once every 2 hours?
• Does blood ever soak through your clothes?
• Do you have to stay off work or cancel social engagements due to bleeding?

If you have answered ‘yes’ to any of the above questions, you are probably suffering from heavy menstrual bleeding.

Note: Many people will experience a one-off ‘heavier than usual’ period over the course of their reproductive life- but this is not the same thing as ‘heavy menstrual bleeding’ (HMB) – which involves a significant loss of blood on a regular basis. If you are over the age of 45, and suddenly start to experience much heavier periods than normal- this may be due to the ‘peri-menopause’- contact your doctor for advice.

Conditions to rule out first, under medical supervision [1];

• polycystic ovary syndrome (PCOS) – a common condition that causes irregular periods and when periods return they can be heavy
• pelvic inflammatory disease (PID) – an infection in the upper genital tract (the womb, fallopian tubes or ovaries) that can cause bleeding after sex, or between periods
• fibroids – non-cancerous growths that develop in or around the womb and can cause heavy or painful periods
• adenomyosis – when tissue from the womb lining becomes embedded in the wall of the womb
• an underactive thyroid gland (hypothyroidism) – where the thyroid gland doesn’t produce enough hormones, causing tiredness, weight gain and feelings of depression
• cervical or endometrial polyps – non-cancerous growths in the lining of the womb or cervix (neck of the womb)
• blood clotting disorders, such as Von Willebrand disease
• cancer of the womb (although this is relatively rare)

Medical treatments that can sometimes cause heavy periods include:

• an IUD (a non-hormonal intrauterine contraceptive device, or ‘the copper coil’) – this can make your periods heavier (especially for the first three to six months after insertion)
• anticoagulant medication (taken to prevent blood clots)- including Aspirin
• some medicines used for chemotherapy

Managing menstrual cycle-related heavy bleeding (i.e. once alternative causes have been ruled out):

TOP TIP 1! Taking 200-400mg of ibruprofen for 2-4 days before a period is due [and during it] can reduce the amount of blood lost (and period pain!)[1]. Track your cycle to identify any ‘tell-tale’ signs of an impending period, and your average cycle length, to help you plan when to start taking the ibuprofen. If this does not help the problem, please consult your doctor.

TOP TIP 2! Menstrual cups hold more blood than other period products, they are also less likely to leak- especially a firm cup e.g. a Mooncup. If you would still prefer to have a ‘backup’ pad, we recommend washable cotton liners or period underwear– they are more economical, better for the environment, more comfortable, and more health-promoting than disposable products. See our independent guide to period products, here.

Try a hormone-balancing diet– As outlined in this blog, a vegetable-based ‘anti-inflammatory’ diet can significantly improve all hormone-related symptoms.We highlight a few of the key steps that are especially relevant for those suffering from heavy bleeding, below:

• Avoid caffeine and alcohol– Although the clinical research is sparse, some studies have found that caffeine, and alcohol, consumption can cause heavier periods [2] [3]. Since a reduction in caffeine and alcohol is beneficial for many other hormone-related symptoms, it is probably worth avoiding them, to see if this reduces the heavy bleeding.
• Try nutritional supplements– Interestingly, iron deficiency can be both a cause and result of heavy periods [4], so it is definitely worth taking an iron supplement (15-50mg daily) to see if this can reduce your menstrual bleeding [5]. You might also want to try taking a daily multivitamin, since studies have shown that vitamins A [6], and C [7], can significantly reduce heavy bleeding in some people.

If you have tried the suggested tips and tricks for at least 3 months, and your symptoms do not improve, please consult your doctor. There are various treatment options available to you [8], from hormonal medication or devices, to surgical procedures.

If you have any other suggestions, or tips, for managing heavy bleeding- please let us know– we can share them with others!

Further information:

• NHS page on heavy bleeding- https://www.nhs.uk/conditions/heavy-periods/
• NHS page on iron deficiency anaemia – http://www.nhs.uk/conditions/Anaemia-iron-deficiency-/Pages/Introduction.aspx
• Verity- UK Polycystic Ovary Syndrome (PCOS) charity-http://www.verity-pcos.org.uk/  

Page last reviewed and updated: June 2019

References:

1. NHS (2016) Heavy Periods. [ONLINE] Available at: http://www.nhs.uk/conditions/Periods-heavy/Pages/Introduction.aspx. [Accessed 30 March 2017].
2. İşik H, Ergöl Ş, Aynioğlu Ö, Şahbaz A, Kuzu A, Uzun M. (2016) ‘Premenstrual syndrome and life quality in Turkish health science students’ Turk J Med Sci. Apr 19;46(3):695-701. doi: 10.3906/sag-1504-140. PubMed PMID: 27513243.
3. Bin Mahmoud, A.Z., Makhdoom, A.N., Mufti, L.A., Alreheli, R.S., Farghal, R.G., & Aljaouni, S. E. (2014) ‘Association between menstrual disturbances and habitual use of caffeine’ Journal of Taibah University Medical Sciences, 9:4, pp. 341-344, ISSN 1658-3612, http://dx.doi.org/10.1016/j.jtumed.2014.03.012
4. Taymor ML, Sturgis SH, Yahia C. (1964) The etiological role of chronic iron deficiency in production of menorrhagia. JAMA 187:323–27.
5. Samuels, AJ. (1965) Studies in patients with functional menorrhagia: the antimenorrhagic effect of the adequate replication of iron stores.  Israel J Med Sci 1:851
6. Lithgow DM, Politzer WM. (1977) ‘Vitamin A in the treatment of menorrhagia’. S Afr Med J Feb 12;51(7):191-3. PubMed PMID: 847567.
7. Cohen JD, Rubin HW. (1960) ‘Functional menorrhagia: treatment with bioflavonoids and vitamin C’. Curr Ther Res 2:539
8. NICE (2018) Heavy menstrual bleeding: assessment and management [NG88] https://www.nice.org.uk/guidance/ng88/chapter/Recommendations#information-for-women-about-hmb-and-treatments