Heavy menstrual bleeding (HMB) can affect many women in the UK, and yet it remains a topic that is under-discussed and even avoided altogether. Whether it’s out of fear or embarrassment, women are worried about revealing their worries about their period.

But actually, HMB might be more common than you realise and  could affect up to 30 per cent of women.

If the start of your period is accompanied by feelings of anxiety, dread and apprehension, it may be time to get to the root of the problem and discover why you feel this way. If you are worried about leaking through your clothes or changing tampons/pads multiple times a day, you may have a heavy period. These worries may even have an impact on your mental health, and could result in cancelled plans, sick days from work or duvet days.

Below, you can find out more about heavy periods. What defines a heavy period, how do you know if yours is heavy and when should you seek advice from a pharmacist or GP? Read on to find out.

How heavy is too heavy for a period?

It can be difficult to compare the heaviness of your period to someone else’s. Everyone has different ideas of what ‘heavy’ is, and every body is different, too. You may even notice a variation from one period to the next.

Women lose, on average, 30 to 40 ml of menstrual blood each cycle. For those with HMB this rises to 80 ml or more of blood loss per cycle. This excessive menstrual blood loss can physically, emotionally, socially, and financially affect the quality of life of women and can be seen by itself or with other symptoms.

But this still may not be particularly helpful when you have nothing to compare against and no way of measuring the exact amount of blood loss that you’re experiencing each month.

Your period might be ‘too’ heavy if you experience the following:

• You regularly leak through your clothes during the day, or onto your bedding at night
• You rely on using two period products at once to stop leaks, such as wearing both a tampon and a pad
• Your periods prevent you from going about your day-to-day activities, including work or social events
• Your period typically lasts more than seven days
• You pass blood clots that are the size of a 10p coin or larger
• You need to change your sanitary products every one or two hours, or change a menstrual cup more than is recommended (e.g. you have to change it every couple of hours instead of every eight hours).

If you use menstrual cups, you may be able to track how much blood you’re losing. Many cups have volume markings in millilitres on the side so you can get a rough idea.

When should I seek medical advice about a heavy period?

It’s easy to say that you can’t do anything about your heavy period because it’s “just the way you are”. However, there are treatments available if you feel like your heavy period is affecting your life in some way, whether emotionally, socially or physically, and there are many causes of heavy periods, including polycystic ovary syndrome, fibroids, endometriosis and pelvic inflammatory disease.

You can seek advice from a pharmacist in the first instance. They may recommend a a product such as Evana that contains tranexamic acid, which can reduce menstrual bleeding by up to 60%.

You should seek advice from a GP if:

• Your periods have been heavy for an extended length of time (i.e. not just for one cycle)
• You can experience severe pain during your period
• You bleed between periods or after sexual intercourse
• You feel that your heavy period is affecting your life (sick days, cancelled plans, anxiety, etc).

Sources

Cox, M, et al. The delivery of heavy menstrual bleeding services in England and Wales after
publication of national guidelines: a survey of hospitals. BMC Health Services Res. 2013; 13:491.

NICE Clinical Knowledge Summaries. Menorrhagia (heavy menstrual bleeding). Last revised March 2023. Accessed October 2023. Available at: https://cks.nice.org.uk/topics/menorrhagia-heavy-menstrual-bleeding/

Bryant-Smith, AC, et al. Antifibrinolytics for heavy menstrual bleeding (review). Cochrane Database of Systematic Reviews. 2018, Issue 4. Art. No.: CD000249.

https://www.nhs.uk/conditions/heavy-periods/ 
Leminen, H, & Hurskainen, R. Tranexamic acid for the treatment of heavy menstrual bleeding: efficacy and safety. Int J Women’s Health. 2012;4:413–421.

Naoulou, B, & Tsai, MC. Efficacy of tranexamic acid in the treatment of idiopathic and non-functional heavy menstrual bleeding: a systematic review. Acta Obstet Gynecol Scand. 2012; 91:529–537.