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What causes heavy periods?

Heavy and/or irregular bleeding are relatively common problems and there are a number of potential causes most of which are benign and easily treated:

  • Fibroids
  • Endometriosis/adenomyosis
  • Hormonal change
  • Endometrial polyps
  • Infection
  • Breakthrough bleeding with hormonal contraception
  • Pre-cancerous or cancerous change (less common)

Diagnosing and treating heavy periods

Persistent abnormal bleeding should always be investigated and tests may include:

  • Swabs for infection
  • Cervical smear (‘Pap’ test)
  • Pelvic ultrasound scan
  • Hormone blood tests
  • Hysteroscopy (a small telescope is used to check inside the womb)

Treatment will depend on the underlying cause but it’s also very important to consider what impact symptoms are having on quality of life. Where tests are reassuring and symptoms are manageable it may be appropriate to do nothing as often over time menstrual cycles can go back to normal.

Generally options are divided into conservative (which essentially means ‘wait and see’), medical or surgical. In many cases several different treatment approaches may be available and ultimately the option that is most acceptable to you as an individual will be the right choice.


Treatments available

Medical treatments

  • Hormonal contraceptives eg the pill or the Mirena ( a hormone releasing coil)
  • Progesterone taken cyclically
  • Tranexamic acid (non-hormonal treatment which can reduce menstrual blood loss by 50% and is only taken on the days of heavy bleeding)

Surgical treatments

Hysteroscopic surgery – problems like polyps or fibroids within the cavity of the womb can be removed very simply using a small telescope as a daycase procedure

TCRE (sometimes called endometrial resection or ablation) – these procedures are performed in the same way as for treatment of polyps or fibroids but instead to remove or destroy the whole of the lining of the womb. The aim of these procedures is to stop bleeding completely and permanently and are clearly only appropriate for women who have completed their family.

Laparoscopic myomectomy – surgical removal of fibroids while preserving fertility.

Laparoscopic hysterectomy – surgical removal of the womb which is a definitive treatment for abnormal bleeding