Visit your GP if you feel that your periods are unusually heavy. Your GP will be able to investigate the problem and offer treatments to help.
Heavy periods (menorrhagia) are diagnosed when both you and your GP agree that your menstrual bleeding is heavy, after details about your periods and medical history have been taken.
Medical history
To establish the cause of your heavy periods, your GP will ask you some questions about:
- your medical history
- the nature of your bleeding
- any related symptoms that you have
Your GP will ask you about your periods. They may ask:
- how many days your periods usually last
- how much bleeding you have
- how often you have to change your tampons or sanitary pads
- whether or not you experience flooding (heavy bleeding through to your clothes or bedding)
- what impact your heavy periods are having on your everyday life
Your GP will also ask you whether you have any bleeding between periods (inter-menstrual bleeding) or after sexual intercourse (post-coital bleeding), and whether you experience any pelvic pain. To help determine the cause of your heavy bleeding, you may have a physical examination, particularly if you have pelvic pain or bleeding between periods or after sex.
You may be asked about the contraception that you currently use, whether you are considering changing it and whether you have any future plans to have a baby. The last time you had a cervical screening test will also be noted.
Finally, your GP may also ask you about your family history to determine whether it is possible that an inherited condition may be responsible for your heavy bleeding. For example, von Willebrand disease, which can run in families, is a coagulation disorder that affects the blood's ability to clot properly.
Further testing
Depending on your medical history and the results of your initial physical examination, the cause of your heavy bleeding may need to be investigated further. For example, if you experience inter-menstrual or post-coital bleeding, or you have pelvic pain, you will need to have some further tests to rule out serious illness, such as an underlying cancer (which is very rare).
If you need to have a pelvic examination, your GP will ask for a female assistant to be present at the time. A pelvic examination will include:
- a vulval examination: an examination of your vulva (external sexual organs) for evidence of external bleeding and signs of infection, such as a vaginal discharge
- a speculum examination of your vagina and cervix (neck of the womb): a speculum is a medical instrument that is used for examining the vagina and cervix
- bimanual palpation: an internal examination of your vagina using the fingers to identify whether your womb or ovaries are tender or enlarged
Pelvic examinations should only be carried out by healthcare professionals who are qualified to perform them, such as a GP or gynaecologist (a specialist in the female reproductive system).
Before carrying out a pelvic examination, the healthcare professional will explain the procedure to you and the reasons why it is necessary. You should ask about anything that you are unsure about. A pelvic examination should not be carried out without your consent (permission).
In some menorrhagia cases, a biopsy may be needed to establish a cause. This will be carried out by a specialist and involves removing a small sample of your womb lining for closer examination under a microscope.
Blood tests
A full blood count is usually carried out for all women who have heavy periods. This can detect iron-deficiency anaemia, which is often caused by a loss of iron following prolonged heavy periods.
If you have iron-deficiency anaemia, you will usually be prescribed a course of medication. Your GP will be able to advise you about the type of medication that is most suitable for you and how long you need to take it for.
See the Health A-Z topic about Iron deficiency anaemia for more information.
Ultrasound scan
If you have heavy menstrual bleeding and the cause is still unknown after you've had tests, an ultrasound examination of your womb may be used to look for abnormalities, such as fibroids (non-cancerous growths) or polyps (harmless growths). Ultrasound can also be used to detect some forms of cancer.
A trans-vaginal scan is often used, which involves a small probe being inserted into the vagina to take a close-up image of your womb.
See the Health A-Z topic about Ultrasound scans for more information.
