Heavy Bleeding

What is heavy bleeding?

The amount of blood women lose each month varies enormously from individual to individual. Some women lose a few teaspoonfuls and hardly notice their periods, whilst others lose enough blood to become anaemic (low blood count). Because of this wide variation, it is impossible to define or describe a “normal” period or to know what is “abnormal” in terms of the amount, length, and frequency of bleeding. What is heavy for one woman may be normal for others. If your periods have changed and are causing you problems then they require investigation and appropriate treatment.

Doctors define menstrual bleeding as heavy (and call it menorrhagia) when more than 80mls of blood is lost during a period. It is possible to measure menstrual blood loss but this is however, not practical. Your perception of the heaviness of your period is as important as any clinical measurement. One of the signs that periods are heavy is when the blood clots. 

There is a simple explanation as to why large clots form. All blood contains a clotting factor. To enable menstrual blood to flow freely from the womb and leave your body without clotting, the womb produces an anti-clotting agent. If the menstrual loss is very heavy, this agent will be used up before a period has finished, and any remaining blood will clot.

What causes heavy bleeding?

There are a number of diseases which can cause heavy bleeding (see picture). We can investigate possible causes and offer treatment if necessary. It is important to remember that in about half the women with heavy bleeding, no cause can be found.

It is important to remember that your periods may be affected by stress and if you are going through any kind of crisis, it is possible that your periods may settle down once that crisis has been resolved. Meanwhile, reassurance from us that there is nothing seriously wrong may help you to accept this change as a common, and usually temporary, response to stress. For many women, however, there is no easy solution to the stress in their lives and if this is the case, you will need to decide whether you want to seek treatment for your heavy bleeding. The main categories of problem bleeding that we encounter are listed below.

Regular heavy bleeding – investigations normal. This may be due to stress, ageing, or for reasons we do not yet fully understand

Irregular periods – investigations normal. If your smear and swabs (to check for any infections down below) are normal, this is most likely to be the result of hormonal imbalance. If the investigations are normal, advice regarding treatment for this problem can be provided.

Regular periods – occasional bleeding after sex or between proper periods. This can be the result of being on the pill, a hormone imbalance, or due to problems with the cervix. If your smear and swabs (to check for any infections down below) are normal, this is most likely to be the result of hormonal imbalance. Advice regarding treatment for this problem can be provided.

Problem bleeding – problem found on investigation. There are many causes of irregular or heavy bleeding. If a problem is found on investigation this can be explained to you, and the best way to manage the problem can be discussed with you.

Bleeding after the menopause. This is usually due to the effects of the menopause. Some tests will be necessary to ensure there are no suspicious circumstances.

How do we investigate problem bleeding?

History: The first thing that we do is to take a detailed and thorough medical history to assess as accurately as possible the nature and extent of the problem.
Examination : We will give you an internal examination if you have not had one from your GP. A cervical smear is taken if indicated.
Investigation : You will have a blood test to check for anaemia (full blood count) and you may need to be checked for an underactive thyroid (thyroid function tests) as this may sometimes present with bleeding problems. A ‘hormone profile’ may be required. This is a blood test that may be taken when you are bleeding, or late in the menstrual cycle.