What should you know about extremely heavy period flow?

Heavy bleeding is a symptom, not a diagnosis. Uterine fibroids, adenomyosis and endometrial polyps can change the structure of the uterus and make bleeding heavier. Hormone-related changes may occur with polycystic ovary syndrome or perimenopause. Less commonly, a thickened uterine lining such as endometrial hyperplasia may be involved. These conditions can present with heavy periods, but heavy bleeding alone cannot identify which cause is present.

Look for the effect on your body as well as the amount of blood. Tiredness, reduced energy, headaches, dizziness, shortness of breath with activity or a racing heartbeat can occur when blood loss contributes to iron deficiency anaemia.

Arrange an appointment with a gynaecologist or another clinician if the pattern is new, worsening, recurring, or disrupting work, sleep, exercise or intimacy. Before the visit, record when bleeding starts and stops, how often you need to change pads or tampons, whether you pass clots, any bleeding between periods, and pain or pressure symptoms. Also note medicines, contraception, pregnancy possibility and a history of easy bruising or prolonged bleeding.

A clinician may examine you and request blood tests for anaemia or iron deficiency. Depending on your history, an ultrasound or another assessment of the uterus may help find a structural cause. Treatment is chosen around the cause, bleeding pattern, pain, pregnancy plans and other health needs. Do not start iron supplements or stop prescribed medicines without checking what is appropriate for you.

Seek urgent medical help if bleeding is very rapid or difficult to control, or if you feel faint, confused, unusually weak, breathless at rest, or have chest pain. Urgent assessment is also needed for severe or worsening pelvic pain, bleeding during a possible pregnancy, or symptoms of shock such as cold, clammy skin. If you are soaking protection repeatedly and cannot keep up with the blood loss, do not wait for a routine appointment.

If the bleeding has settled but you remain exhausted, dizzy or short of breath, arrange prompt assessment for anaemia and its cause.

Ask what could be causing the change in flow and whether you need a blood count, iron tests or an ultrasound. Ask which treatment options fit your pregnancy plans, whether your contraception or medicines could affect bleeding, and which symptoms should send you to urgent care. If you have pain, pressure, irregular cycles or bleeding between periods, mention each one because it can guide the assessment.