Heavy Periods (Menorrhagia)

During the 28-day menstrual cycle, the female body readies itself for pregnancy. Fluctuations in different hormones affect the reproductive system. The cycle is split into 3 phases; the follicular phase, the ovulatory phase, and the luteal phase.

During the follicular phase, the lining of the womb (endometrium) is shed through a period. A hormone stimulates the growth of up to 30 follicles in the ovaries. One follicle will continue to grow and release an egg.

The ovulatory phase is the time when the developed egg is released from the ovaries, ready to be fertilised. During this time, the oestrogen levels decrease, and the progesterone levels increase.

The final stage, known as the luteal phase, lasts for approximately two weeks. During this time, the follicle which released an egg changes into a structure called a corpus luteum. The corpus luteum will secrete increasing levels of progesterone.

Progesterone promotes the growth of blood vessels responsible for the maintenance of the endometrium (the lining of the womb). It helps to thicken the fluids in the uterus to provide a potential embryo with nutrients to grow.

The levels of oestrogen and progesterone remain high throughout the luteal phases. If pregnancy does not occur, the levels of progesterone and oestrogen decrease and the endometrium breaks down and is removed from the body as a period, marking the start of a new cycle.

To help shed the lining of the womb, the smooth muscle of the uterus contracts vigorously. These contractions can compress blood vessels, cutting off their supply of oxygen. When the oxygen supply is cut off, the tissues in your womb release pain-causing chemicals and prostaglandins.

What are heavy periods?

It can be difficult to determine whether a period is heavy, as the amount bled during a period is different between women. Though you would have an idea of how much blood you lose during your period and would know when it changes.

If you notice a change in your period, speak to your doctor. These changes could include:

• Bleeding lasting for longer than normal
• Bleeding more than normal
• Blood clots in your period (larger than 2.5cm)
• Needing to use 2 sanitary products at the same time (such as tampons and pads)
• Pain lasting longer than usual
• Pain which is more intense than usual
• Using more sanitary products than usual

Other indications of heavy periods include bleeding through your clothes or bedding. It's important to understand that while heavy periods can be embarrassing, they are very common. It's estimated that a third of women would describe their period as heavy, and 1 in 20 women speak to their GP about the problem annually.

What causes heavy periods?

Defining a heavy period is challenging as every woman's period is different. On average, most women will lose 80ml of blood during their period. Heavy bleeding is then defined by losing more than 80ml of blood.

This measurement is not a requirement in determining whether your period is heavy. You should know whether your period is heavier than usual. If you do notice that you are bleeding more than usual or bleeding between periods, you should speak to your doctor, as it may be a sign of an underlying condition.

Heavy periods can be caused by a number of conditions, including but not limited to:

• Blood clotting disorders
• Diabetes
• Endometriosis
• Hypothyroidism
• Pelvic inflammatory disease
• Polycystic Ovary Syndrome

For this reason, it is important to speak to your doctor if your periods are heavier than usual.

What causes painful periods?

During the menstrual cycle, a woman's body prepares itself for pregnancy by thickening the lining of the womb, known as the endometrium, to allow a fertilised egg to implant itself and develop.

However, if a pregnancy doesn't occur then the lining is no longer needed, and so the body sheds the lining, eradicating it from the body in the form of a period.

Period pain is caused by the muscles which surround the womb. These muscles contract to aid the shedding of the womb's lining, resulting in abdominal pain.

As every woman has a different pain threshold, the amount of pain one woman can stand is different to another. If you notice that your periods have become more painful than usual, or that you are finding the pain to be interfering with your day-to-day life, speak to your doctor or gynaecologist about it.

Treating heavy and painful periods

If your periods are getting in the way of your life, you should speak to your doctor about possible treatments you can take.

While some women may find relief from pain with the use of paracetamol, others may find other pain relief treatments such as anti-inflammatory painkillers (including Ibuprofen and Naproxen) to be more effective for treating period pain.

For heavy periods, Tranexamic acid tablets may be taken. Tranexamic acid causes blood in your uterus to clot, resulting in less bleeding.

A lot of women find relief from taking Tranexamic acid tablets alongside non-steroidal anti-inflammatory drugs (NSAIDs). However, this treatment isn't suitable for everyone.

Prescription Doctor offers 3 treatments:

• Primolut N
• Provera
• Utovlan

All 3 of the above treatments contain a progestogen - sometimes called progestin - which is a synthetic hormone which mimics a naturally occurring hormone called progesterone.

Primolut N and Utovlan contain norethisterone, while provera contains medroxyprogesterone acetate.

Progesterone is a female sex hormone produced by cells in the ovaries and by the placenta during pregnancy. This hormone plays a vital role in regulating the female reproductive system.

The two key roles of progestogen in the female reproductive system are increasing the viscosity of vaginal fluids, which affects the motility of sperm, and maintaining the lining of the endometrium. During labour, progesterone makes it harder for the smooth muscle of the uterus to contract.

While progesterone levels are high, the endometrial lining is sustained. When they drop at the end of the menstrual cycle, the uterine lining is shed, and a period occurs.

By keeping the progesterone levels high, by taking a progestogen, the uterus stays prepared for pregnancy, and a period doesn't occur until the level of progesterone drops. This is why norethisterone is also used to delay periods.

When taken to treat heavy periods, progestogens do not provide contraceptive protection. Therefore, you should use other contraceptive methods, such as condoms, to prevent pregnancy.

The combined oral contraceptive (COC) pill contains an oestrogen and a progestogen to regulate menstrual cycles and protect women against unwanted pregnancy. They can help to regulate periods, making them lighter and less painful.

If you are unsure which treatment suits you, speak to your doctor or a gynaecologist about your periods before buying treatment online. They can discuss your options and help you decide which route to take.

Authored & Reviewed By

Mohamed Imran Lakhi

MPharm - Lead Pharmacist

This content has been written and checked for quality and accuracy by Imran Lakhi is the superintendent pharmacist and founder at Prescription Doctor. He has been at the core of our team.

Published on: 18/02/2020 Reviewed on: 18/05/2023