Dark red heavy period: what it may mean

Blood can look dark red when it takes longer to leave the uterus and becomes more exposed to air. Colour alone does not show whether bleeding is healthy or harmful. Pay attention to how often you need to change period products, whether bleeding disrupts sleep or daily activities, and whether clots, pelvic pressure, tiredness or breathlessness occur. Heavy periods may be linked with adenomyosis, uterine fibroids, endometrial polyps, changes in the uterine lining, perimenopause or polycystic ovary syndrome. Ongoing blood loss can contribute to iron deficiency anaemia.

Record the first and last day of bleeding, the colour changes, clots, pain and how frequently products are changed. Arrange a clinician visit if this pattern is new, repeatedly heavy or affecting work, sleep or exercise. An assessment may include questions about medicines, pregnancy possibility and cycle changes, followed by an examination or tests chosen for your symptoms. Do not start iron tablets solely because bleeding is heavy; ask whether a blood test is appropriate and which treatment fits the cause.

Seek urgent medical help if bleeding is very heavy and you feel faint, weak, short of breath, confused or unable to stand safely. Urgent review is also appropriate with severe or worsening pelvic pain, fever, or possible pregnancy. Contact a clinician promptly when heavy bleeding keeps returning, starts after a long change in your usual cycle, or comes with marked fatigue or dizziness.

Ask: Could the flow and colour fit a change in my cycle, or should we check the uterus and blood count? Could my medicines or contraception be contributing? What signs should make me seek urgent help? If iron is low, how will it be treated and reviewed?