Heavy pain during periods: what to know

Strong cramps can occur when the uterus contracts, but pain that disrupts work, sleep, or normal activity is worth discussing. Heavy bleeding may involve soaking protection quickly, passing large clots, or bleeding for longer than your usual pattern. Causes can include adenomyosis, uterine fibroids, endometrial polyps, hormonal changes around perimenopause, polycystic ovary syndrome, or changes in the womb lining. Heavy bleeding can also contribute to iron deficiency anaemia, which may cause tiredness, breathlessness, headaches, or paleness.

Record when bleeding starts and stops, how often you change pads or tampons, clot size, pain severity, and any missed activities. A clinician may ask about pregnancy possibility, medicines, contraception, bleeding between periods, and family history. They may consider an examination, blood tests, or imaging based on your pattern. Do not start iron or anti-inflammatory medicine without checking that it is suitable for you, especially if you have stomach, kidney, bleeding, or pregnancy concerns.

Seek urgent help if bleeding is rapidly soaking through protection, or if you feel faint, confused, unusually weak, short of breath, or have severe worsening pain. Fever, a positive pregnancy test with pain or bleeding, or sudden one-sided pelvic pain also needs prompt assessment. If symptoms are recurrent but stable, arrange a routine appointment rather than waiting for them to become harder to manage.

Ask what could explain the combination of pain and bleeding, whether you need a blood count or iron testing, and whether an ultrasound is appropriate. Ask which pain-relief options fit your health history, how treatment may affect fertility or contraception, and what change should prompt urgent review.