GYNAECOLOGY
Heavy periods, an unpredictable cycle or bleeding you were not expecting deserve a clear explanation. Start with the pattern that fits you, then explore assessment and treatment.
START WITH WHAT MATTERS TO YOU
Choose the concern that sounds closest to yours. You can also book a consultation if you are unsure.
FURTHER GUIDANCE
Bleeding after menopause, bleeding after sex and pregnancy-related bleeding need their own assessment. The symptom guides above can help you find the right starting point.
Periods arriving at unpredictable intervals are different from periods that have stopped altogether. We review the pattern, pregnancy possibility, medicines and other symptoms to decide what assessment is useful.
If bleeding is also heavy or prolonged, the treatment options below may be relevant after assessment. If you have missed several periods, start with the missed or absent periods guide.
Spotting or bleeding between your expected periods deserves assessment if it is persistent, recurrent or unexplained. Tell us if it also happens after sex, if pregnancy is possible, or if you use hormonal treatment or blood-thinning medicines.
The cause guides the checks: these may include examining the cervix, ultrasound or assessment of the womb lining. Heavy bleeding or feeling acutely unwell needs the urgent care described above.
Whether bleeding is expected depends on your HRT regimen and when it was started or changed. New, persistent, heavy or unexpected bleeding should be discussed with your clinician rather than assumed to be a hormone effect.
Bring the names and doses of your HRT, any recent changes and a record of the bleeding. We review the pattern and your risk factors to decide whether treatment adjustment or investigations are needed.
Bleeding before periods have started, periods that have not started, and changes around menopause each need their own assessment.
YOUR CONSULTATION
We discuss timing, amount, pain, medicines, contraception and any chance of pregnancy. A pregnancy test may be needed. Bring a record of your cycles and previous results if you have them.
Assessment may include an examination, ultrasound or hysteroscopy (a camera examination inside the womb). A small sample of the lining, called an endometrial biopsy, may be needed depending on the bleeding pattern and risk factors.
Reducing bleeding, easing pain, avoiding hormones, preserving fertility and considering surgery can lead to different choices. We work through those choices together.
If a procedure is recommended, we discuss pain relief and the appropriate setting beforehand. Your comfort, preferences and previous experiences help guide the plan.
THE EFFECT OF BLOOD LOSS
Heavy periods can deplete iron stores and cause anaemia. Low iron may affect your energy even before anaemia develops.
For heavy periods, we check a full blood count and assess whether iron-store tests, such as ferritin, would be helpful. A normal haemoglobin result does not always exclude iron deficiency.
Tell us about tiredness, dizziness or reduced exercise tolerance. We discuss iron replacement when needed while addressing the cause of the bleeding.
TREATMENT WITH DR JAN ADLAM
I offer medical and surgical treatments for heavy periods. We choose a treatment together based on the cause, your health, the effect on daily life and your plans for pregnancy.
A 52 mg hormonal device placed in the womb can be an initial treatment for heavy periods in suitable patients, as well as providing contraception. The cause of bleeding, the shape of the womb cavity and your preferences guide the choice.
Explore hormonal intrauterine devicesTranexamic acid and, when suitable, anti-inflammatory medicines (NSAIDs) can reduce bleeding. NSAIDs may also ease period pain. We check your medical history and other medicines before choosing treatment.
Explore non-hormonal treatmentHormonal tablets can help reduce bleeding and regulate your cycle. The choice depends on your symptoms, health and whether you also need contraception.
Explore hormonal tabletsA camera procedure to examine the inside of the womb. It can help identify the cause of bleeding and treat findings such as polyps when appropriate.
Explore hysteroscopyI offer endometrial ablation to reduce heavy menstrual bleeding in suitable patients who do not plan a future pregnancy. We assess whether it is appropriate and discuss the alternatives.
It is not contraception: reliable contraception is needed if pregnancy is possible. Periods may become lighter without stopping completely, and further treatment is sometimes needed.
Explore endometrial ablationAn operation to remove the womb, considered when appropriate for your symptoms, findings and preferences. We discuss alternatives and the surgical approach.
Explore hysterectomyIf fibroids are contributing to your bleeding, their size and position can affect the options. Read about fibroids and their treatment.
COMMON QUESTIONS
Heavy periods are about their effect on your life, not only the amount of blood lost. Signs include needing very frequent changes of period products, bleeding through clothing or bedding, using more than one product at a time, or avoiding work, exercise or other activities because of bleeding.
You do not need to measure blood loss before asking for help. If bleeding is sudden or very heavy, or you feel unwell, follow the urgent-care advice above.
No. Arrange prompt assessment even if it was light or happened only once. Many causes are benign, but the cause needs to be established. Heavy bleeding with faintness, chest pain, significant breathlessness or severe pain needs emergency care.
Pain and bleeding often overlap. The pain page may be a better starting point if painful periods or persistent pelvic pain are the main problem.
A medication list, the dates and pattern of bleeding, and any scan reports or previous blood results. You can book even if you have not had tests.
YOUR NEXT STEP
Consultations in Claremont, with additional appointments in Simon’s Town on selected Mondays. Reception will confirm your date, time and venue.
General information to support your consultation. Your assessment and treatment plan are individual.
Page updated: .
Further reading: NHS: heavy periods · NHS: bleeding in pregnancy · NHS: bleeding after menopause · NICE: heavy menstrual bleeding · FDA: endometrial ablation
Clinical references: ASH: iron deficiency · BMS: bleeding on HRT · RCOG: hysteroscopy