Heavy periods - Diagnosing heavy periods

Visit your GP if you feel your periods are unusually heavy. Your GP will investigate the problem and offer treatments to help.

Heavy periods (menorrhagia) are diagnosed when both you and your GP agree your menstrual bleeding is heavy, after details about your periods and medical history have been taken.

GP consultation

To establish the cause of your heavy periods, your GP will ask about:

your medical history
the nature of your bleeding
any related symptoms that you have

They will also ask questions about your periods, including:

how many days your periods usually last
how much bleeding you have
how often you have to change your tampons or sanitary pads
whether or not you experience flooding (heavy bleeding through to your clothes or bedding)
what impact your heavy periods are having on your everyday life

Your GP will want to know if you have any bleeding between periods (intermenstrual bleeding) or after sexual intercourse (postcoital bleeding), and whether you experience any pelvic pain.

To help determine the cause of your menorrhagia, you may have a physical examination, particularly if you have pelvic pain or bleeding between periods or after sex.

Your GP is likely to want to know the contraception you currently use, whether you are considering changing it and whether you have any future plans to have a baby. The last time you had a cervical screening test will also be noted.

They will also ask about your family history to rule out inherited conditions that may be responsible, such as Von Willebrand disease, which runs in families and affects the blood's ability to clot properly.

Further testing

Depending on your medical history and the results of your initial physical examination, the cause of your heavy bleeding may need to be investigated further.

For example, if you experience intermenstrual or postcoital bleeding or have pelvic pain, you will need further tests to rule out serious illness, such as an underlying cancer (which is very rare).

Pelvic examination

If you need to have a pelvic examination, your GP will ask if you would like a female assistant to be present. A pelvic examination will include:

a vulval examination – an examination of your vulva (external sexual organs) for evidence of external bleeding and signs of infection, such as a vaginal discharge
a speculum examination of your vagina and cervix (neck of the womb) – a speculum is a medical instrument used for examining the vagina and cervix
bimanual palpation – an internal examination of your vagina using the fingers to identify whether your womb or ovaries are tender or enlarged

Pelvic examinations should only be carried out by healthcare professionals who are qualified to perform them, such as a GP or gynaecologist (a specialist in the female reproductive system).

Before carrying out a pelvic examination, the healthcare professional will explain the procedure to you and the reasons why it is necessary. You should ask about anything you are unsure about. A pelvic examination should not be carried out without your permission.

Biopsy

In some menorrhagia cases, a biopsy may be needed to establish a cause. This will be carried out by a specialist and involves removing a small sample of your womb lining for closer examination under a microscope.

Blood tests

A full blood test is usually carried out for all women who have heavy periods. This can detect iron deficiency anaemia, often caused by a loss of iron following prolonged heavy periods.

If you have iron deficiency anaemia, you will usually be prescribed a course of medication. Your GP will be able to advise you about the type of medication most suitable for you and how long you need to take it for.

Ultrasound scan

If you have heavy menstrual bleeding and the cause is still unknown after you've had tests, an ultrasound scan of your womb may be carried out to look for abnormalities such as fibroids (non-cancerous growths) or polyps (harmless growths). Ultrasound can also be used to detect some forms of cancer.

A transvaginal scan is often used, which involves a small probe being inserted into the vagina to take a close-up image of your womb.