Heavy menstrual bleeding affects millions of women, yet far too many put up with it quietly—thinking it’s just part of being female. Others don’t realise that effective treatments exist. The truth is, heavy periods can take a huge toll on everyday life, but with the right care, most women see remarkable improvements.
What counts as heavy?
In medical textbooks, heavy menstrual bleeding is defined by numbers and measurements. But in real life, it’s simpler: if your periods interfere with your physical, social, emotional, or financial well-being, they’re heavy.
Think of a teenager missing school and sports every month. Or a woman struggling to concentrate at work because her iron levels have dropped from constant blood loss. These are not minor inconveniences—they’re life-changing disruptions.
How common is it?
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Depending on how you measure it, between a quarter and a half of women of reproductive age experience heavy periods. Yet it remains under-recognised, often brushed aside as 'normal'.
Why does it happen?
Here’s the tricky part: in up to 80 per cent of women, no clear cause is found—even after thorough investigation. That doesn’t make the symptoms any less real or important.
When there is a cause, it may be:
• Fibroids (benign growths in the uterus)
• Uterine polyps
• Adenomyosis or endometriosis
• Polycystic ovarian syndrome (PCOS)
• Rarely, precancerous or cancerous changes in the uterine lining
How is it assessed?
Doctors usually start with a conversation: how long your periods last, how regular they are, how much blood you lose, and how it affects your daily life. Associated symptoms—pain, fatigue, headaches, nausea—are also important.
Basic investigations often include:
• An ultrasound scan
• Blood tests for anaemia and iron levels
What can be done?
The good news is that there are many treatment options.
Medical management
• Tablets first: Non-steroidal anti-inflammatory drugs (NSAIDs) and tranexamic acid can reduce bleeding. Hormonal tablets like the pill or progesterone-only options are also used.
• The Mirena IUD: This small device placed inside the uterus is the most effective medical treatment. Clinical studies show blood loss can drop by 86 per cent within three months, and by up to 97 per cent after a year. Many specialist bodies now recommend it as the first-line option.
Surgical options (when medicines aren’t enough)
• Endometrial ablation: Removing or destroying the uterine lining.
• Hysteroscopic surgery: Removing fibroids or polyps through a small camera inserted into the uterus.
• Uterine artery embolisation: Blocking the blood supply to large fibroids.
• Laparoscopy or open surgery: For larger fibroids that can’t be removed via hysteroscopy.
Hysterectomy
A hysterectomy—removing the uterus—offers a permanent solution. But because less invasive treatments are now so effective, it’s usually considered only after other options have failed or aren’t suitable. Importantly, the ovaries are not removed unless there’s another reason to do so.
Final word
If heavy periods are affecting your life, don’t dismiss them as 'normal'. Talk to your doctor. With various treatments, most women can expect significant relief and a return to living fully—without the constant shadow of heavy bleeding.
Dr Johnson Kuttiyil Joseph is a UK-trained, consultant gynaecologist & laparoscopy surgeon working in Nowra, NSW, Australia.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
