What Counts as Heavy Menstrual Bleeding?
Clinically, heavy menstrual bleeding (HMB) is defined as blood loss of more than 80ml per menstrual cycle. In practice, this is impossible to measure at home — but there are practical indicators that suggest your periods are heavier than they need to be:
Volume indicators
- Changing a pad or tampon every 1–2 hours
- Passing clots larger than a 50p coin
- Bleeding through onto clothing or bedding
- Needing to use a pad and tampon together
Impact indicators
- Periods lasting longer than 7 days
- Avoiding activities, exercise, or work during your period
- Persistent fatigue (possibly iron deficiency)
- Feeling anxious about where you are when bleeding is heavy
If several of the above apply to you, your periods are objectively heavy and warrant investigation — even if a previous doctor has normalised them.
Common Causes of Heavy Menstrual Bleeding
Heavy periods are a symptom, not a diagnosis. The most common underlying causes include:
- Uterine fibroids: Benign muscle tumours of the uterine wall. Very common — up to 70% of women develop fibroids by age 50. Large or submucosal fibroids (those that distort the uterine cavity) cause the heaviest bleeding.
- Adenomyosis: Endometrial-type tissue embedded within the uterine muscle itself, causing the uterus to be enlarged, tender, and prone to heavy bleeding. Often co-exists with endometriosis.
- Endometrial polyps: Small benign growths on the inner lining of the uterus. Can cause heavy or irregular bleeding.
- Hormonal imbalance: Including anovulatory cycles (when ovulation doesn't occur), perimenopause, and PCOS — all of which lead to oestrogen-dominant states and thicker uterine lining.
- Thyroid disorders: Hypothyroidism in particular is closely associated with heavy, irregular periods.
- Coagulation disorders: Von Willebrand disease affects an estimated 1% of women and frequently presents with heavy periods — it is significantly underdiagnosed.
What a Private Gynaecology Appointment Involves
At Lambert Medical Practice, your appointment with our GP with specialist interest in gynaecology will include a detailed menstrual history covering cycle length, duration, volume, pain, and associated symptoms. An abdominal and pelvic examination is offered. Key investigations that may be arranged include:
- Full blood count and ferritin — to assess for iron deficiency anaemia from blood loss
- Thyroid function tests
- Coagulation screen (if coagulation disorder is suspected)
- Hormonal panel (FSH, LH, oestradiol, AMH if relevant)
- Pelvic ultrasound — to assess for fibroids, adenomyosis, polyps, and ovarian cysts
Treatment Options
Treatment depends entirely on the underlying cause and your own preferences regarding hormonal vs non-hormonal approaches. Options range from the hormonal intrauterine system (highly effective for most causes of HMB), combined oral contraceptive pill, progesterone preparations, and non-hormonal options such as tranexamic acid, to referral for surgical management (hysteroscopic polypectomy, fibroid treatment, or endometrial ablation) where appropriate.
Book a Gynaecology Appointment
If your periods are affecting your quality of life, a private gynaecology appointment at Lambert Medical Practice provides thorough assessment, investigation, and a treatment plan — without waiting months for an NHS referral.