Heavy bleeding is defined by its effect on you rather than by a measured volume. It has effective treatments, hormonal and non hormonal, and most start without any investigation. A ferritin should be checked in every case. A 30 minute consultation is £150 and a blood panel is £350.
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Any of these needs to be seen the same day. If you are severely unwell, go to your nearest emergency department or call 999.
Heavy menstrual bleeding is bleeding that interferes with your physical, social or emotional life. There is no volume you have to reach. If you plan your work, your clothes or your travel around your period, that is the definition met.NICE NG88, 2021
It affects around 1 in 3 women at some point and is one of the commonest reasons women see a GP. Most of it is treatable in general practice without a scan and without surgery.Royal College of Obstetricians and Gynaecologists RCOG guidance, 2022
In many women no structural cause is found. In the rest the usual causes are fibroids, adenomyosis, polyps, a coil, thyroid disease and, less often, a bleeding disorder that has been present since your first period.NICE NG88, 2021
The commonest consequence is iron deficiency, with or without anaemia, and it explains the tiredness, the breathlessness on stairs and the hair shedding that women often bring as separate complaints.New England Journal of Medicine Camaschella, 2015
Send us what you are seeing and we will tell you what it is likely to be.
The appointment starts with the history, because the pattern of bleeding is what points at the cause. An examination is offered where there is pain, bleeding between periods, or a suspicion of a structural cause, and it is not required before treatment can start.NICE NG88, 2021
A full blood count and a ferritin are checked in every case. Ferritin below 30 micrograms per litre indicates iron deficiency even when haemoglobin is normal, and that is the reading that explains how you feel.Gut Snook, 2021
An ultrasound is arranged where the uterus feels enlarged, where there is bleeding between periods or after sex, or where first line treatment has not worked. Bleeding after the menopause is a different pathway and is referred urgently.NICE NG12, 2015
Tranexamic acid
Taken only on the heavy days. It reduces blood loss by roughly a third, is not a hormone and does not affect fertility, so it suits women trying to conceive.NICE NG88, 2021
Anti inflammatory tablets
Reduce bleeding and period pain together. Less effective than tranexamic acid for volume and useful where pain is the bigger problem.NICE NG88, 2021
The hormonal coil
The most effective medical treatment for heavy bleeding and the one recommended first where a woman is happy with a hormonal method. It is fitted by a clinician and is not a procedure this clinic currently offers.Faculty of Sexual and Reproductive Healthcare FSRH clinical effectiveness unit, 2023
The combined pill or cyclical progestogen
Both reduce bleeding and give predictable cycles. Suitability depends on your blood pressure, migraine history and smoking status.Faculty of Sexual and Reproductive Healthcare UKMEC, 2016
Iron replacement, alongside whichever of these you choose
Treating the bleeding without correcting the iron leaves the symptom that made you notice. Oral iron taken on alternate days is absorbed better than daily dosing.American Journal of Hematology Auerbach, 2016
Treatment is judged over 3 cycles rather than one. Tranexamic acid works from the first period you use it. Hormonal treatments take 3 to 6 months to settle, and irregular spotting in the first 3 months is expected rather than a failure.NICE NG88, 2021
Correcting iron takes longer than most people expect. Haemoglobin recovers in 4 to 8 weeks and refilling the stores takes 3 to 6 months of continued treatment, so stopping when you feel better is what causes it to return.American Journal of Hematology Auerbach, 2016
Track two cycles before the appointment. Day of bleeding, how many pads or tampons, any flooding, any clots larger than a 10 pence coin, and how many days you changed your plans. That record does more to direct treatment than any test.
If you are already on iron, take it every other day rather than daily, with vitamin C, and never with tea, coffee or milk. Spacing the doses raises how much gets in and settles the stomach, which is why people stay on it long enough to work.American Journal of Hematology Auerbach, 2016
Ask for the ferritin figure rather than for a normal or abnormal. Stores empty long before a blood count changes, so a haemoglobin inside the range tells you nothing about whether the bleeding has cost you.World Health Organization WHO/NMH/NHD/MNM/11.1, 2011
Do not buy a pelvic ultrasound as a first step if your periods are regular and heavy with no pain and no bleeding between them. First line treatment can start without it, and the scan changes nothing in most of these cases.NICE NG88, 2021
Do not buy a high dose iron infusion before oral iron has been tried properly and has either failed or been tolerated badly. Oral iron corrects most cases at a fraction of the cost, and that is a fee we are turning down by saying so.American Journal of Hematology Auerbach, 2016
Step 1
What your periods actually do, how much they cost you, and a full blood count with ferritin at the same visit.
Step 2
A prescription chosen around whether you want contraception, whether you are trying to conceive, and what your blood pressure and migraine history allow.
Step 3
Against the diary rather than against an impression. If the first choice has not worked the second one is not a fresh start, it is the next step.
Ask before you book if you are not sure this is the right appointment.
There is no measured volume. It is heavy if it interferes with your life, which in practice means flooding, clots, changing protection more than every 2 hours, or planning your week around it. That definition is the one clinicians use and it is deliberately about you.
Usually not. Where periods are regular and heavy with no pain and no bleeding between them, treatment can start without imaging. A scan is arranged where the womb feels enlarged, where there is bleeding between periods or after sex, or where first line treatment has failed.
Often, yes. A ferritin is checked in every case because iron can be depleted while haemoglobin is still normal, and that is what explains the tiredness and the breathlessness. The Core panel including ferritin and thyroid is £350.
Yes. Tranexamic acid is taken only on the heavy days, is not hormonal and does not affect fertility, so it is the usual choice while you are trying. Hormonal options are held back until you are not.
A 30 minute consultation is £150, the blood panel with ferritin and thyroid is £350, and the review by telephone at 3 cycles is £59. Where hormones and full thyroid are needed the Advanced panel is £650. Prescriptions are dispensed and priced separately.
Not at present. The hormonal coil is the most effective medical treatment for heavy bleeding, so where that is the right answer we say so and arrange the fitting rather than steering you towards something we do offer.
Tranexamic acid works from the first period you take it on. Hormonal treatments need 3 to 6 months, and unpredictable spotting in the first 3 months is part of settling rather than a sign it is not working. The review at 3 cycles is where that is judged.
This page is general information about a condition and it is not a diagnosis. Treatment depends on what a doctor finds when they examine you, and no outcome is guaranteed. If you are severely unwell, or if any of the warnings at the top of this page apply to you, go to your nearest emergency department or call 999.
American Journal of Hematology
How we diagnose and treat iron deficiency anaemiaAuerbach, 2016
Faculty of Sexual and Reproductive Healthcare
UK medical eligibility criteria for contraceptive useUKMEC, 2016
Faculty of Sexual and Reproductive Healthcare
Intrauterine contraception, clinical guidelineFSRH clinical effectiveness unit, 2023
Gut, British Society of Gastroenterology
Guidelines for the management of iron deficiency anaemia in adultsSnook, 2021
New England Journal of Medicine
Iron deficiency anaemiaCamaschella, 2015
NICE
NICE
Heavy menstrual bleeding, assessment and managementNG88, 2021
Royal College of Obstetricians and Gynaecologists
Heavy menstrual bleeding, patient and clinical informationRCOG guidance, 2022
World Health Organization
Haemoglobin concentrations for the diagnosis of anaemia and assessment of severityWHO/NMH/NHD/MNM/11.1, 2011
Written by the clinical team at The Wellness. Awaiting clinical sign off.
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