Heavy or irregular periods: what's normal, what isn't, and what to do about it
Bleeding that soaks through protection faster than usual, disrupts your day, or turns up between periods or after menopause is worth investigating — not something to just live with. It is one of the most common reasons women come to see us, it is almost always manageable once the cause is found, and there is nothing to be embarrassed about in bringing it up.
What counts as "heavy"
There is no single number that applies to everyone, but a few practical signs are worth paying attention to:
- Soaking through a pad or tampon faster than every one to two hours, on your heaviest days.
- Needing to change protection during the night, or using two forms of protection together to cope.
- Passing clots that are large — bigger than a coin.
- Periods lasting longer than about seven days.
- Bleeding heavy enough that it stops you doing your normal daily activities.
- Any bleeding between periods, after sex, or any bleeding at all after menopause — these need prompt attention regardless of how light they are.
Common causes
Abnormal bleeding has several possible causes, and the right treatment depends entirely on which one applies to you:
Hormonal imbalance
The lining of the uterus is built up and shed under hormonal control. When that balance is disturbed — which is common around the start of periods, around menopause, or with conditions like polycystic ovaries — bleeding can become heavy or irregular even though the uterus itself is structurally normal.
Fibroids
Non-cancerous growths in the muscle wall of the uterus are one of the most common causes of heavy periods, particularly when a fibroid sits close to or bulges into the uterine cavity. See our page on uterine fibroids for more detail.
Polyps
Small growths of the uterine lining that can cause bleeding between periods or heavier-than-usual periods, often removable in a short, minor procedure.
Other causes
Thyroid disorders, blood-clotting conditions, certain contraceptive methods, and — particularly for bleeding after menopause — changes in the uterine lining that need direct investigation. Each of these is checked for individually rather than assumed.
How it's investigated
The work-up is straightforward and rarely takes more than one or two visits to complete:
- History. How heavy, how often, and for how long — this alone narrows down the likely cause considerably.
- Examination. A pelvic examination to check the uterus and look for anything obviously abnormal.
- Ultrasound. A scan of the uterus and ovaries to look for fibroids, polyps, or changes in the lining.
- Blood tests. To check for anaemia from the blood loss itself, and sometimes thyroid or clotting function.
- Hysteroscopy, where needed. A thin telescope passed through the cervix gives a direct look inside the uterine cavity, and can sometimes treat what it finds — such as a small polyp — in the same visit.
Treatment options
Treatment follows the cause, and starts with the least invasive option that is likely to work:
- Medication. For many women, hormonal or non-hormonal medication brings bleeding back under control without any procedure at all.
- Minor procedures. A polyp or a small fibroid bulging into the cavity can sometimes be removed through a hysteroscopy, with no cut on the abdomen.
- Myomectomy. Where fibroids are the cause and are more than a hysteroscopy can manage, they can be removed while keeping the uterus in place — see myomectomy.
- Hysterectomy. Kept for the cases that have not responded to the steps above, or where the bleeding and its cause make removing the uterus the right long-term answer.
Most women are managed with medication or a minor procedure; surgery is the exception, not the starting point.
Who assesses you
Dr. Mayur Pai (MBBS, MS Obstetrics & Gynaecology), a laparoscopic surgeon of 15 years, carries out the examination and, where an operation is needed, performs it himself in the hospital's own operating theatre. If you are travelling from elsewhere in Goa for a scan or a procedure, we send a car for you and bring you home again, free of cost.
How much bleeding counts as "too heavy"?
As a practical guide: soaking through a pad or tampon faster than every one to two hours, passing large clots, or bleeding that stops you doing your normal daily activities. Any bleeding between periods or after menopause should also be checked, regardless of how light it is.
Is heavy bleeding always caused by fibroids?
No. Hormonal imbalance, polyps, thyroid disorders and other causes are all common. An ultrasound and, sometimes, a hysteroscopy help identify which applies to you.
Will I need surgery?
Usually not. Most abnormal bleeding is managed with medication or a minor procedure. Surgery such as myomectomy or hysterectomy is kept for cases that need it specifically.
Is bleeding after menopause serious?
It needs prompt investigation regardless of how light it is, simply because it is not expected once periods have stopped. Most causes are treatable once identified.
This page is for general education and is not personal medical advice. Treatment depends on your own examination and reports, so please speak to a doctor about your situation. We do not carry out or offer sex determination of any kind.