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Health condition · Clinically reviewed

Heavy periods, the causes, the tests, and the treatments that actually work.

Flooding, clots, anaemia and days lost to a period aren’t just a fact of life. Modern UK care starts with a simple ladder that helps most women within weeks.

Prefer the full clinical reference? See our companion guide at heavy menstrual bleeding.

Jump to treatment
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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a UK gynaecologist before publication.

  • 02

    Sourced from guidance

    Checked against NICE NG88, RCOG Green-top guidance and peer-reviewed sources listed at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including PALM-COEIN classification, Mirena IUS first-line care and uterus-preserving surgery.

Key facts

Heavy periods at a glance.

The essentials in plain English: what counts as heavy, how the UK classifies the causes, and how modern treatment is stepped.

  • What it is

    Menstrual blood loss that interferes with a woman’s physical, social, emotional or material quality of life. Also known as menorrhagia or heavy menstrual bleeding.

  • How common

    Around 1 in 4 women of reproductive age report periods heavy enough to affect daily life. A leading reason for gynaecology referral in the UK.

  • Classification

    PALM-COEIN framework by FIGO: structural causes (Polyp, Adenomyosis, Leiomyoma, Malignancy) and non-structural causes (Coagulopathy, Ovulatory, Endometrial, Iatrogenic, Not otherwise classified).

  • First-line therapy

    The levonorgestrel intrauterine system (Mirena IUS) is the recommended first-line medical option in NICE NG88 for most women wanting long-term relief.

  • Short-term relief

    Tranexamic acid and NSAIDs such as mefenamic acid are taken during the period itself and can reduce bleeding by 30 to 50 per cent.

  • When to escalate

    Persistent symptoms, women over 45, failed medical treatment or intermenstrual bleeding prompt endometrial biopsy and hysteroscopy to rule out pathology.

Why this guide matters

A clear ladder, not a lifetime of coping.

Heavy periods are common, treatable and rarely need to be tolerated. The three points below shape the rest of this page.

  • Classify before you treat

    PALM-COEIN separates structural causes from hormonal and other causes so that treatment targets the actual problem.

  • Mirena is a game changer

    The levonorgestrel IUS is the recommended first-line medical option for most women and works for up to 8 years.

  • Surgery preserves the uterus

    Modern options like uterine artery embolisation, myomectomy and ablation keep the uterus where possible - hysterectomy is definitive but no longer the only route.

How the diagnosis is made

From first appointment to a clear plan.

The steps a UK GP or gynaecologist normally follows, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and bleeding pattern

    Cycle length, flow, flooding, clot size, pad and tampon use, impact on work and sleep, plus family history of bleeding disorders.

  2. 02

    Assessing

    Examination and smear check

    Abdominal and speculum examination to look for a bulky uterus, cervical lesions or polyps. Ensure cervical screening is up to date.

  3. 03

    Assessing

    Full blood count

    A haemoglobin and ferritin check is essential. Iron-deficiency anaemia is the commonest complication of heavy menstrual bleeding.

  4. 04

    Confirming

    Coagulation and thyroid tests

    Consider von Willebrand screening in women with heavy bleeding since menarche or a family history. Thyroid function only if clinically indicated.

  5. 05

    Confirming

    Transvaginal ultrasound

    The imaging test of choice for suspected fibroids, adenomyosis, endometrial polyps or ovarian pathology.

  6. 06

    Preparing

    Endometrial biopsy if needed

    Recommended for women over 45, persistent intermenstrual bleeding or failure of medical treatment, to exclude endometrial hyperplasia or cancer.

  7. 07

    Preparing

    Hysteroscopy for cavity assessment

    Direct visualisation of the endometrial cavity is offered when ultrasound suggests a polyp, submucosal fibroid or when biopsy is inconclusive.

Typical timeline: from first GP visit to a settled plan in a few weeks, longer if hysteroscopy is needed.

Symptoms

What heavy periods actually look like.

Flooding, clots and prolonged bleeding are the classic mix. And the features that mean it’s time to escalate rather than tolerate.

  • Flooding and clots

    Passing large clots or soaking through pads or tampons every hour or two on the heaviest days.

  • Prolonged bleeding

    Periods lasting longer than 7 days, or a shorter cycle that leaves little pad-free time between periods.

  • Iron-deficiency anaemia

    Tiredness, breathlessness on stairs, pale skin, brittle nails and cravings for ice or non-food items.

  • Pelvic pain and pressure

    Dragging or cramping pain, often worse with fibroids or adenomyosis, sometimes with urinary frequency.

  • Impact on daily life

    Missing school or work, avoiding exercise, planning outfits around bleeding and repeated laundry emergencies.

  • Cyclical mood and fatigue

    Premenstrual low mood, sleep disruption from night-time changes and post-period exhaustion linked to blood loss.

  • Change from usual pattern

    A new pattern of heavier or longer periods, especially after 40, deserves review even if bleeding still feels manageable.

  • Red flag - bleeding between periods

    Intermenstrual or postcoital bleeding, or any postmenopausal bleeding, needs prompt gynaecology review, not reassurance.

Treatment

How heavy periods are treated in the UK.

Medical first with the Mirena IUS, tranexamic acid and NSAIDs. Surgical options step in when medical treatment fails, when fibroids are large, or when family is complete.

  • Mirena IUS (levonorgestrel)

    First-line long-acting option in NICE NG88. Reduces blood loss by around 90 per cent at one year, lasts up to 8 years and doubles as contraception.

  • Tranexamic acid

    Antifibrinolytic taken only during the period. Cuts blood loss by 40 to 50 per cent, non-hormonal, safe for women trying to conceive.

  • NSAIDs (mefenamic acid)

    Reduces bleeding by around 30 per cent and eases cramping pain. Often combined with tranexamic acid for a bigger effect.

  • Combined oral contraceptive

    Regulates the cycle and lightens bleeding. A reasonable choice when contraception is also wanted and there is no cardiovascular risk.

  • Progestogens (norethisterone, POP)

    Short-course norethisterone for acute heavy bleeding, or continuous progestogens for ongoing suppression when other options are unsuitable.

  • GnRH analogues

    Short-term suppression before surgery, especially to shrink fibroids. Usually given with add-back hormone therapy to protect bone density.

  • Endometrial ablation

    Day-case procedure that removes the womb lining. Suits women who have completed their family and have a normal cavity.

  • Uterine artery embolisation

    Interventional radiology procedure for fibroids. Blocks the fibroid blood supply, shrinks fibroids and preserves the uterus.

  • Myomectomy

    Surgical removal of fibroids while keeping the uterus. Laparoscopic, hysteroscopic or open depending on fibroid size and position, especially for women planning pregnancy.

  • Hysterectomy

    Definitive treatment for women who have completed their family and want a guaranteed end to bleeding. Vaginal, laparoscopic or open route.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or gynaecologist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Heavy menstrual bleeding: assessment and management (NG88).

  • Royal College of Obstetricians and Gynaecologists (RCOG). Best practice in outpatient hysteroscopy.

  • FIGO. PALM-COEIN classification of abnormal uterine bleeding in the reproductive years.

  • British Society for Gynaecological Endoscopy (BSGE). Standards for endometrial ablation and hysteroscopic surgery.

  • Cochrane Reviews. Antifibrinolytics, NSAIDs and the levonorgestrel IUS for heavy menstrual bleeding.

Red flags

When heavy periods need urgent review.

Most heavy periods are manageable in primary care. These are the situations that aren’t, and where a specialist opinion is needed sooner.

  • Postmenopausal bleeding

    Any bleeding after 12 months of amenorrhoea needs urgent gynaecology assessment to exclude endometrial cancer.

  • Persistent intermenstrual bleeding

    Bleeding between periods, especially with pelvic pain or an abnormal smear, warrants prompt referral for hysteroscopy.

  • Bleeding after intercourse

    Postcoital bleeding needs speculum examination and cervical review to exclude a polyp, ectropion or cervical pathology.

  • Symptoms of severe anaemia

    Marked breathlessness, chest pain, dizziness or fainting during a period needs same-day assessment, not a routine appointment.

  • Rapidly enlarging uterus

    A quickly growing pelvic mass or new pressure symptoms may indicate a fibroid that needs imaging and specialist review.

  • Bleeding disorder features

    Heavy periods since menarche with easy bruising, prolonged bleeding after dental work or a family history warrants coagulation testing.

  • Failed first-line treatment

    If bleeding remains disabling after 3 to 6 months of appropriate medical therapy, escalation to imaging and specialist review is appropriate.

  • New symptoms after 45

    A change in bleeding pattern in the perimenopause deserves endometrial assessment even when the woman feels otherwise well.

  • Cancer risk factors

    Obesity, tamoxifen use, unopposed oestrogen, Lynch syndrome or PCOS increase endometrial cancer risk and lower the threshold for biopsy.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest daily difference: treat the anaemia, track the cycle, plan practically for heavy days, and don’t accept periods that dominate your life.

A quiet reminder

Heavy is not the same as normal.

A period that soaks through overnight, forces you to plan your outfit or leaves you exhausted is worth reviewing, whatever your friends or family may say.

  1. 01 Iron

    Treat the anaemia

    Oral iron for 3 months after haemoglobin normalises. Take with vitamin C, avoid tea at the same time and expect dark stools.

  2. 02 Track

    Keep a period diary

    Cycle-tracking apps or a paper chart help you and your clinician see the pattern, response to treatment and any warning changes.

  3. 03 Practical

    Plan for heavy days

    Overnight pads, menstrual cups and period underwear give practical control. Keep a spare kit at work and in your bag.

  4. 04 Escalate

    Don’t accept disabling periods

    If bleeding still floods clothes, disrupts sleep or forces days off work, ask about a Mirena IUS or specialist referral.

Frequently asked

Everything we get asked about heavy periods.

Quick answers on PALM-COEIN, Mirena IUS, tranexamic acid, biopsy timing and surgical options.

  • What counts as a heavy period?

    The modern NICE definition is excessive menstrual blood loss that interferes with a woman’s physical, social, emotional or material quality of life. Practical markers include flooding through clothes, passing clots larger than a 10 pence coin, changing protection every hour or two, or periods lasting longer than 7 days. Any of these is enough to seek help.

  • What is PALM-COEIN and why does it matter?

    PALM-COEIN is the FIGO framework for classifying abnormal uterine bleeding. PALM covers structural causes visible on imaging (Polyp, Adenomyosis, Leiomyoma, Malignancy) and COEIN covers non-structural causes (Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise classified). It helps target the right investigation and treatment rather than treating every heavy period the same way.

  • Why is the Mirena coil recommended first?

    The levonorgestrel intrauterine system releases a small daily dose of progestogen directly into the womb, thinning the endometrium. It reduces blood loss by around 90 per cent at one year, works for up to 8 years, doubles as contraception and avoids surgery. NICE NG88 recommends it as first-line medical therapy for most women with heavy menstrual bleeding.

  • When will I be offered an endometrial biopsy?

    A biopsy is offered when the risk of endometrial hyperplasia or cancer is raised, typically in women over 45, when bleeding is persistent or unresponsive to treatment, when there is intermenstrual bleeding, or when ultrasound suggests a thickened endometrium. It is usually taken as an outpatient Pipelle sample or during hysteroscopy.

  • What if fibroids are causing the bleeding?

    Options depend on fibroid size, number and position, and on whether you want future pregnancy. Uterine artery embolisation shrinks fibroids while preserving the uterus. Myomectomy removes fibroids and keeps fertility potential. Hysterectomy provides definitive treatment when family is complete. A specialist will map fibroids on ultrasound or MRI before recommending an approach.

  • How is this page different from your heavy menstrual bleeding guide?

    This is a plain-language companion to our full clinical page at /conditions/heavy-menstrual-bleeding/. Both pages cover the same UK guidance, but this version uses everyday language for women searching for information about heavy periods. If you want the more technical clinical reference, use the heavy menstrual bleeding guide instead.

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