Heavy Periods: Causes, Symptoms, and Modern Treatment Options

Heavy periods are common, but they are not normal. Many women silently suffer from excessive menstrual bleeding, assuming it is part of womanhood. In reality, heavy menstrual bleeding is a medical condition with identifiable causes and effective treatments. Understanding what is considered heavy, why it happens, and what can be done can help you take control of your health.

What Are Heavy Periods?

A period is considered heavy when the amount or duration of bleeding interferes with daily life.

You may have heavy menstrual bleeding if you experience:

• Blood loss of more than 80 ml per cycle

• Passing large blood clots (normal menstrual blood does not clot)

• Soaking through pads or tampons every 1–2 hours

• Leakage that soils clothes or bed sheets

• Periods lasting longer than 6 days

• Feeling tired, dizzy, or breathless due to anemia from heavy periods

If your period controls your routine, it is time to seek medical advice.

Why Do Heavy Periods Occur?

Hormonal Imbalance

Delayed or absent ovulation causes the uterine lining to become excessively thick, leading to heavy bleeding. Common hormonal causes include:

• PCOS

• Thyroid disorders

• High prolactin levels, often related to stress

• Adolescence and perimenopause

Nutritional Deficiencies

• Vitamin D deficiency, which affects calcium absorption and normal blood clotting

• Iron deficiency, which both results from and worsens heavy bleeding

Uterine Causes

Structural problems in the uterus often lead to heavy menstrual bleeding:

• Fibroids, which increase the bleeding surface and reduce uterine contraction

• Adenomyosis, where the uterine muscle becomes swollen and painful

• Endometrial polyps

• Congenital anomalies such as a double uterus

Medical Devices and Infections

• Copper IUD (Copper-T) can increase menstrual flow

• Pelvic or uterine infections, which increase blood supply to the uterus

Bleeding Disorders and Cancer

• Underlying bleeding disorders

• Use of blood-thinning medications

• Endometrial or cervical cancer, especially in women over 40 or with postmenopausal bleeding

When Should You See a Gynaecologist?

Seek medical help if:

• Heavy bleeding affects work or daily activities

• Periods are getting heavier or longer

• Bleeding occurs between periods or after intercourse

• You feel constantly fatigued or weak

Your gynaecologist may recommend:

• A clinical examination

• Pelvic ultrasound

• Blood tests (hemoglobin, hormones, thyroid levels)

• Endometrial evaluation when needed

Treatment Options for Heavy Periods

Medical Treatment

Treatment depends on the underlying cause and your future fertility plans. Options include:

• Progesterone therapy for hormonal imbalance

• Haemostatic medicines to control bleeding

• Tranexamic acid and pain-relieving medicines

• Hormonal pills

• Progesterone-releasing intrauterine device

• Treatment of infections or nutritional deficiencies

• Iron and vitamin supplements to correct anemia

Surgical Treatment

If medicines are ineffective or structural problems are present, surgery may be advised:

• Dilatation and Curettage (D&C) to remove thickened uterine lining

• Hysteroscopic polypectomy

• Myomectomy for fibroid removal

• Ovarian cyst surgery

• Hysterectomy, after careful discussion of benefits and risks

What’s New in the Treatment of Heavy Periods?

Advances in gynaecology now allow many women to avoid major surgery:

• HIFU (High-Intensity Focused Ultrasound) for fibroids and adenomyosis

• Uterine artery embolisation to shrink fibroids

• Long-term medications such as GnRH antagonists to control symptoms

Can Heavy Periods Be Prevented?

While not all causes are preventable, you can reduce risk by:

• Maintaining a healthy weight

• Eating an iron-rich, balanced diet

• Ensuring adequate Vitamin D and calcium

• Exercising regularly and managing stress

• Attending regular gynaecological check-ups

• Treating irregular cycles early

Final Thoughts

Heavy periods are treatable and manageable. Ignoring excessive menstrual bleeding can lead to severe anemia and may delay the diagnosis of serious conditions. If your periods feel overwhelming, remember — help is available, and you don’t have to suffer in silence.

If you are experiencing heavy menstrual bleeding, consult a gynaecologist and take the first step toward better health.

Amenorrhoea

 Amenorrhea is the absence of menses - it may be primary or secondary

Primary Amenorrhoea:

Primary amenorrhoea occurs when a girl hasn't started menstruating by the age of 16.

Causes:
   - Genetic disorders like Turner syndrome where one X chromosome is missing or 

Mayer-Rokitansky-Küster-Hauser syndrome) ( absent uterus) 
   - Hormonal imbalances (e.g., hypogonadotropic hypogonadism where stimulating hormones are deficient
   - Anatomical abnormalities (e.g., imperforate hymen, vaginal agenesis)
   - Chronic illnesses (e.g., thyroid disorders, diabetes, tuberculosis)

Secondary Amenorrhoea:

Secondary amenorrhoea occurs when a woman who previously menstruated stops getting periods for three months or more.

Causes:

Chronic disease like anaemia or tuberculosis 

Deficiency of Vitamin D and Calcium which is needed for ovulation

Hormonal imbalances (e.g., polycystic ovary syndrome (PCOS), thyroid disorders, excess Prolactin hormone
Pregnancy or breastfeeding
Weight changes or extreme exercise both severe weight gain or weight loss. Athlete’s amenorrhea sometimes occurs in women training for marathons etc when Prolactin production increases
Stress or emotional trauma
Certain medications (e.g., Proton pump inhibitors like Pantoprazole, omeprazole etc, antidepressants, antipsychotics)
Underlying medical conditions (e.g., premature ovarian failure, pituitary gland problems)

Symptoms associated

Absence of menstrual period

Pallor iron or B12 deficiency anaemia is read by the body as a bad time to have a baby. Nature take care by stopping ovulation causing amenorrhea 

Hormonal imbalances:
   - Mood swings
   - Weight gain or loss
   - Hair loss or excessive hair growth
   - Acne
Infertility:
   - Difficulty getting pregnant
   - Irregular ovulation
Other symptoms may vary depending on the underlying cause:
   - Hot flashes (menopausal symptoms)
   - Galactorrhea (milk production not associated with childbirth or nursing)
   - Headaches or vision problems (pituitary gland issues)

Symptoms of underlying disease like tuberculosis- cough, weight loss,  appetite loss

Treatment Options:

1 Medication to treat underlying condition like   Correction of anaemia, thyroid disorder, prolactin excess, diabetes or raised insulin, vitamin D and calcium deficiency 

   - Birth control pills or patches to regulate menstrual cycles
   - Hormone replacement therapy (HRT) for menopausal symptoms
   - Medications to stimulate ovulation in cases of infertility 

2. Lifestyle changes:
   - Maintaining a healthy weight through diet and exercise
   - Reducing stress through relaxation techniques (e.g., yoga, meditation)
   - Getting enough sleep and practicing good sleep hygiene

3 Surgery:
   - Surgery to correct anatomical abnormalities (e.g., hymenectomy for imperforate hymen)
   - Surgery to remove tumors or cysts that may be causing hormonal imbalances
    - Surgery to remove intra uterine scarring and allow growing back of the inner lining

Conclusion:
Amenorrhoea can be a complex condition, but with proper diagnosis and treatment, many women can experience regular menstrual cycles and improved overall health. It's essential to consult a healthcare provider for personalized guidance and care.