Heavy periods: how to tell, why it happens, and what actually helps

Some women bleed lightly. Some bleed enough to soak through protection every hour. The medical term for genuinely heavy bleeding is menorrhagia, and it affects roughly 1 in 5 women at some point. Most cases have a specific, treatable cause.

How to know if your periods are actually heavy

You're likely in the "heavy" range if you have any of these:

• Soaking through a pad or tampon every 1–2 hours for several hours
• Needing to change protection during the night
• Passing clots larger than a Rs 5 coin (about 2.5 cm)
• Bleeding for more than 7 days
• Feeling tired, lightheaded, breathless, or noticing hair loss (all signs of iron loss)

Common causes

• Fibroids — very common, especially in your 30s and 40s
• Polyps — small growths in the uterine lining
• Adenomyosis — lining tissue in the muscle of the uterus
• Hormonal imbalance — anovulation, PCOS, thyroid issues, perimenopause
• Bleeding disorders — sometimes an undiagnosed clotting issue is the first sign
• Copper IUD can make periods heavier, especially in the first year
• Medications — blood thinners

Iron loss is the big issue

Heavy bleeding is the leading cause of iron-deficiency anaemia in women worldwide. You can be anaemic without knowing it. Symptoms creep in: constant fatigue, low mood, dizziness on standing up, poor concentration, hair thinning, pica (craving ice or unusual textures). A cheap blood test — haemoglobin + ferritin — settles it.

Ferritin is often normal-range but low; ideal is above 30 ng/mL, and heavy bleeders often need it above 50 to feel well. Iron infusions can restore levels quickly if tablets aren't working.

What your doctor may do

• Blood tests: haemoglobin, ferritin, thyroid, sometimes clotting studies
• Pelvic ultrasound (transvaginal is more detailed)
• Endometrial biopsy if you're over 40 or have unusual bleeding

Effective treatments (in rough order of first choice)

1. Tranexamic acid — a tablet taken during your period; reduces bleeding by roughly 50%. Non-hormonal, safe for most women.
2. Hormonal IUD (Mirena) — often the single most effective option; reduces bleeding by 90%+ in most women.
3. Combined pill or progesterone-only pill
4. Iron replacement if levels are low
5. Surgical options (removal of fibroids or polyps; rarely, ablation or hysterectomy) — only when medical options fail

When to see a doctor

• Any of the "how to know" signs above
• Bleeding is affecting your work, sleep, or social life
• You feel tired all the time
• Sudden change in your usual pattern