Heavy bleeding, painful periods and irregular cycles are among the most common reasons women come to see us — and among the most likely to be quietly endured for years. They are not something you have to put up with. Most have treatable causes.

Heavy periods (menorrhagia)

Periods are heavy if they interfere with your life: soaking through pads or tampons, passing large clots, flooding, needing to change protection at night, or simply planning your month around your bleeding. Heavy periods are also a common cause of iron-deficiency anaemia, which is why we often check your blood count.

Common causes

  • Hormonal imbalance
  • Fibroids
  • Polyps in the womb lining
  • Adenomyosis
  • Endometriosis
  • Thyroid problems and, less often, bleeding disorders

How we treat it

Medical treatment comes first. Tablets are the starting point for most women — tranexamic acid to reduce the flow, anti-inflammatories such as mefenamic acid, which also help with pain, and hormonal treatments including the combined pill.

If medical treatment does not work, the next step is usually the hormonal coil.

The hormonal coil (LNG-IUS)

The LNG-IUS is a small device fitted inside the womb that releases a low dose of hormone directly where it is needed. It thins the womb lining, and for many women it reduces bleeding dramatically or stops periods altogether. It lasts several years, works as contraception at the same time, and can be removed whenever you choose.

We offer it as the second-line treatment for heavy bleeding, once tablets have been tried. It does involve an upfront cost, and we will talk that through with you openly — affordability is a legitimate part of choosing between the options, and there is no need to feel awkward raising it.

Where medical treatment and the coil have not worked, or where there is a structural cause such as large fibroids, procedures such as endometrial ablation, myomectomy or hysterectomy may be considered.

Painful periods (dysmenorrhoea)

There are two kinds:

  • Primary — period pain with no underlying disease. Common, and usually well controlled with simple measures.
  • Secondary — pain caused by an underlying condition such as endometriosis, adenomyosis or pelvic infection. This tends to start later in life, worsen over time, or last beyond the period itself.

Treatment starts with pain relief — paracetamol and mefenamic acid are the usual choices — along with heat and gentle exercise. Hormonal treatments such as the combined pill or the hormonal coil help many women. Where a secondary cause is suspected, we investigate and treat that cause directly.

Pain that stops you working, studying or sleeping is not normal, however often you have been told otherwise. Please come and see us.

Irregular periods

Cycle length varies naturally, and an occasional odd month is not a problem. Persistent irregularity is worth investigating. Common causes include polycystic ovary syndrome, thyroid problems, significant weight change, stress, and the natural transition towards menopause.

Assessment usually involves a history, an examination, blood tests including thyroid function, and often an ultrasound scan. Treatment depends on the cause and on whether you are trying to conceive.

When to seek help

Make an appointment if you have:

  • Bleeding heavy enough to disrupt your daily life
  • Period pain that stops you doing normal activities
  • Periods that have changed noticeably from your usual pattern
  • Bleeding between periods or after sex
  • Any bleeding after the menopause — this always needs assessment
  • Symptoms of anaemia: tiredness, breathlessness, palpitations

The bottom line

Heavy, painful and irregular periods are common and treatable. For heavy bleeding we start with tablets and move to the hormonal coil if those are not enough. Period pain that disrupts your life deserves investigation rather than endurance. Whatever your age, if your periods are affecting how you live, come and talk to us.

References

  1. National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. NG88. London: NICE; 2018. Available from: https://www.nice.org.uk/guidance/ng88
  2. National Health Service. Periods [Internet]. NHS; [cited 2026 Jul 22]. Available from: https://www.nhs.uk/conditions/periods/
  3. National Health Service. Heavy periods [Internet]. NHS; [cited 2026 Jul 22]. Available from: https://www.nhs.uk/conditions/heavy-periods/
  4. Kadir RA, Chi C. Menstrual problems in adolescent girls: a primer for the practitioner. J R Soc Med. 2020;113(2):52–59.