On average women lose about 2.5 tablespoons of blood every period, but some women lose more
than 5.5 tbs (80ml), which is defined as menorrhagia. Blood loss is usually greatest on the second or third day.
Many women have occasional flooding and it’s quite common to pass clots. However, bleeding between
periods or after sexual intercourse may need quick attention so see your doctor as soon as possible.

There are several possible causes of heavy bleeding:

• stopping taking the contraceptive pill
• large fibroids (see below)
• endometriosis (see below)
• polyps in the womb
• problems with the Pill or mini-Pill
• contraceptive coils (IUDs) especially copper-containing ones
• pelvic infections including chlamydia
• blood clotting problems
• anaemia (may cause heavy bleeding or be caused by it)
• thyroid problems
• cancer of the womb (very rare)
• hormonal imbalances affecting ovulation, such as PCOS (see below)
• idiopathic (no known cause) menorrhagia

Diagnosis will be based on your medical and contraceptive history, physical examination (including internal),
blood tests (for anaemia and possibly thyroid disorders); further tests include more extensive blood tests,
ultrasound scan, hysteroscopy and endometrial biopsy.

Without treatment, the bleeding often becomes lighter. It stops at the menopause anyway
(if that’s not too far off) and large fibroids often shrink then too.

Drugs may help some women, as may the contraceptive Pill or the progesterone–releasing Mirena coil.
Eat well and certainly give up smoking.

If you are anaemic, iron supplements will be prescribed. Surgery is also possible, including several methods
of endometrial ablation (which shaves away the womb lining), or a hysterectomy if bleeding is uncontrollable
by all other methods.

An integrated approach will include:

• Weight Management as being overweight can be associated with heavy periods
• Exercise – can improve the situation
• Acupuncture
• Aromatherapy
• Herbal treatment
• Homeopathy

If in doubt, give a shout.