Heavy menstrual bleeding

Heavy menstrual bleeding is defined as menstrual loss in excess of 80mls.

At the end of a menstrual cycle, if pregnancy does not occur, hormonal support to the endometrium or ‘lining layer’ of the uterus is withdrawn and the endometrium is shed as a period. It is a popular misconception that a woman bleeds during a period, the majority of the menstrual loss is endometrial tissue, which resembles blood, but actual bleeding is not a major part of a normal period.

Heavy menstrual bleeding affects in excess of 15% of women at some time during their menstrual lives and involves the loss of significant amounts of blood in addition to the endometrium. Associated factors include fibroids, endometriosis or adenomyosis, infection and, rarely, cancer. 

Symptoms and signs

Women with heavy menstrual bleeding complain of the need to change their sanitary protection with increasing frequency, the need to use double protection (tampons and towels), and of getting up in the middle of the night to change sanitary protection. Classic symptoms of heavy menstrual bleeding include ‘flooding’ and the passage of blood clots during a period. Pain is not usually a feature of heavy menstrual bleeding and implies that there may be co-existent problems.


There are a number of treatment options for heavy menstrual bleeding and treatment should be based on the patient’s choice after a full discussion of the risks and benefits of each method.

Possible treatments include: non-hormonal medication, hormone treatment (the contraceptive pill or the Mirena intra-uterine system or coil), endometrial ablation, and hysterectomy. Hysterectomy is the only method that guarantees success in that no woman will have a period after hysterectomy. Hysterectomy has one of the highest patient satisfaction rates of any operation and should be included in any discussion of treatment options for heavy bleeding. For more information, see Hysterectomy.