Heavy menstrual bleeding (HMB): what to watch for and what helps
Is your period soaking a pad or tampon every hour, lasting more than seven days, or leaving large clots? That’s heavy menstrual bleeding (HMB), and it’s more common than you think. HMB can cause tiredness, low iron, missed work or school, and real stress. You don’t have to accept it as "normal."
Simple signs of HMB: changing protection every hour for several hours, periods >7 days, passing clots larger than a quarter, or needing to use double protection. If you wake at night to change a pad, or your life is getting disrupted, get help.
Common causes and tests
Several issues can cause heavy bleeding. Fibroids and polyps are frequent culprits. Adenomyosis (when the uterus lining grows into the muscle) and ovulation problems also show up as HMB. Medical causes include thyroid problems, bleeding disorders, and some medications such as anticoagulants or a copper IUD. Perimenopause can change bleeding patterns too.
Doctors usually start with a pregnancy test and blood tests: full blood count and ferritin (iron stores) plus thyroid checks. A pelvic ultrasound helps look for fibroids or polyps. If results are unclear or you’re over 45, a hysteroscopy or endometrial biopsy may be advised to check the uterine lining.
Treatment options that work
Many effective treatments exist. Tranexamic acid is an antifibrinolytic that can cut bleeding by about half when used on heavy days (commonly 1 g three times daily while bleeding is heavy). Talk to your doctor if you have a history of blood clots. NSAIDs like ibuprofen or naproxen reduce bleeding and ease cramps (ibuprofen often 400 mg every 4–6 hours as needed, within safe limits).
Hormonal choices are often very effective. Combined oral contraceptives can shorten and lighten periods. The levonorgestrel IUD (Mirena) is one of the most reliable options — many people see major reduction in flow or no periods at all after a few months. Progestin-only pills or injections can help when estrogen isn’t suitable.
If structural problems are found, procedures matter. Polypectomy or myomectomy removes polyps or fibroids while preserving the uterus. Endometrial ablation reduces bleeding for those who don’t want more children. Hysterectomy ends bleeding permanently but is a major operation and usually a last option.
Because heavy bleeding often causes iron loss, check ferritin and start iron if needed. Ferrous sulfate or alternative iron supplements can help; taking iron every other day improves absorption and cuts side effects. Recheck blood tests after 8–12 weeks.
Practical tips: track your bleeding with an app, bring that record to appointments, and use high-absorbency products or menstrual cups for better control. If you consider buying medications online, use trusted pharmacies and clear it with your clinician first.
If HMB affects your daily life, push for testing and a clear treatment plan. You deserve care that stops the bleeding and helps you feel like yourself again.
