Heavy periods

Heavy menstrual bleeding

Heavy menstrual bleeding (HMB) is when you lose a lot of blood each period. It's a term used by doctors if your periods are so heavy that they're interrupting your life.

How much bleeding is too much?

Not everyone bleeds the same amount. The important thing is to learn what's normal for you and talk to your GP if you're worried.

During an average period, most people bleed for 3 to 7 days and lose up to 60 mL of blood. Your bleeding is probably heavy if you:

• bleed for more than 8 days
• lose more than 60 mL of blood each period
• have to change your pad, tampon, period underwear, disc or cup more often than recommended
• pass large or frequent clots
• sometimes have a sudden gushing of blood – also known as flooding
• need to use 2 types of protection together – for example a tampon and a pad
• often bleed through to your clothes or bedding
• have to get up in the night to change your period protection
• feel very tired while you have your period.

You can tell roughly how much you're bleeding by tracking how often you need to change your period products. On average a:

• menstrual cup holds 30 to 60 mL and should last up to 12 hours
• menstrual disc holds 50 to 70 mL and should last up to 12 hours
• regular tampon or pad holds 5 mL and should last between 4 and 8 hours
• super tampon or pad holds 10 to 15 mL and should last between 4 and 8 hours.

If you're using period underwear it can be difficult to track how much blood you're losing. If you need to change your underwear more than once a day and use an extra type of protection, you may be bleeding heavily.

Causes

In the first 2 to 5 years after your periods start, they can be heavy because you're not producing eggs regularly yet. Cycles where you don't produce an egg are called anovulatory cycles. Anovulatory cycles are often the cause of heavy bleeding in adult women as well.

Other causes of heavy bleeding can include:

• fibroids or polyps in your womb (uterus)
• polycystic ovary syndrome (PCOS)
• endometriosis or adenomyosis
• thyroid problems
• pelvic infections or STIs (sexually transmitted infections)
• pregnancy complications like a miscarriage or an ectopic pregnancy
• bleeding disorders
• medicines and supplements.

There's a small chance heavy bleeding could be caused by cancer.

Talking to your GP

Talk to your GP if you’re worried about your periods or they’re stopping you from going to work or school, or from doing things you enjoy.

Before you see your GP, keep track of your cycle and symptoms, and include things like:

• how often and how long you bleed for
• roughly how much you bleed each cycle
• what the blood looks like (dark, bright red, jelly-like clots)
• any other symptoms you're having, like pain, tiredness or feeling dizzy
• how long you've had heavy periods for
• if you've had to miss school or work
• if it's stopping you doing things you enjoy
• if it's affecting your mental health.

Take a list of medicines and supplements you're taking. Sometimes these can affect how much you bleed.

Diagnosis

To help find out what's causing your heavy periods, your GP may do:

• blood tests
• physical examinations, like feeling your tummy or checking your cervix
• imaging tests, like an ultrasound or MRI.

They may also refer you to a gynaecologist for more tests. A gynaecologist is a doctor who specialises in women's reproductive health. If you're under 16 you may see a paediatric and adolescent gynaecologist who specialises in younger people.

It's important to try and understand what's causing the heavy bleeding, so you can get the right treatment. But it's not always possible to find a cause.

Treatments

If your GP knows what's causing your heavy bleeding, they'll suggest some specific treatments.

Other treatments that might help include:

• hormonal contraception to thin the lining of your womb, like an IUD or the pill
• progesterone (if you're under 16 and in the first 5 years of your period starting)
• a medicine called tranexamic acid that controls bleeding by helping your blood to clot
• anti-inflammatory painkillers like mefenamic acid or naproxen
• iron supplements or infusions if you have iron deficiency anaemia.

Your GP may also talk to you about having a hysterectomy (removing your womb) if other treatments haven't helped.

Managing heavy periods

Heavy periods don't always need treatment. If they're not affecting your quality of life, you can try managing them yourself by:

• using a menstrual cup or disc that holds more blood, so you don't need to change it as often
• sleeping on a towel or period blanket to protect your sheets
• using period activewear and swimwear so you can keep doing things you love
• eat foods that are rich in iron or take supplements.

Read more about heavy periods on the healthdirect website.

Talking to your child about heavy periods

Talk to your child about what’s normal for them and what signs might mean they’re losing too much blood. If they’re missing out on things they enjoy because of bleeding or pain, help them talk to their GP about their symptoms.

Please see your GP if your child is:

• missing school
• unable to perform to their full capacity
• tired and sleeps a lot
• has distressing pain and bleeding.

Your GP can offer simple treatments that can reduce the bleeding, improve iron levels, and get them back to doing the things they enjoy.