Heavy periods: key points
If you change protection every 1 to 2 hours, if your periods last more than 7 days, if you feel drained — your periods aren't in the normal range, and solutions exist.
One woman in four lives through this. Yet nearly one in two never talks about it — out of habit, modesty, or because she thinks "that's just how it is".
Clotting issues, pregnancy, fibroid, polyp, adenomyosis, endometriosis, hormones, or more rarely a cancer — all of this can be diagnosed.
A blood test and an ultrasound are usually enough to understand what's going on.
The pill, the hormonal IUD, anti-bleeding medications — surgery only comes in after these have failed or a specific cause has been identified.
Several options exist, and some of them fully preserve your uterus and fertility.
A few figures
To understand heavy periods at a glance.
You change protection constantly, your periods seem to never end, and you feel completely drained for several days each month. This isn't normal — but it doesn't have to be your reality. One woman in four goes through this at some point in her life. Yet nearly one in two never mentions it to a doctor, out of habit, modesty, or because she assumes "that's just how it is". It isn't. This article answers the questions you may be asking yourself: when should you start to worry? What could be causing it? Which tests should you ask for? And when is it time to consider surgery?
When do periods become too heavy?
Doctors have a numerical definition — above 80 mL of blood loss per cycle. But let's be honest: nobody measures their flow with a measuring cup. What matters is your daily experience.
Signs that should alert you
If you recognise yourself in several of these situations, your periods are probably not in the normal range:
- You change protection every 1 to 2 hours during the day, several days in a row.
- Your periods last more than 7 days.
- You wear two forms of protection at once (tampon plus pad) to prevent leaks.
- You need to get up at night to change protection.
- You plan your life around your periods — cancellations, dark clothing, refusing social plans, fear of leaking at work.
- You feel unusually exhausted during and after — breathlessness on exertion, dizziness, pale complexion.
Why you shouldn't just accept it
Living with heavy periods has a real cost, which is often underestimated. Iron deficiency anaemia affects nearly 4 out of 10 women with heavy periods — and many don't know it. If climbing stairs leaves you breathless, if you look pale, if your heart races for no reason, it's often anaemia speaking. Beyond the body, there's also the mental load: the fear of leaks in meetings, avoiding activities, broken nights, dropping focus at work. It's not in your head, and it isn't your "normal" daily life.
Keep a record, spot the patterns
Noting dates, duration and intensity of your periods over two or three cycles gives your doctor a true picture of your situation. A mobile app or a simple paper calendar will do.
This concrete data is what makes it possible to objectively assess any anomaly and to direct the workup quickly down the right path.
Where does it come from? Possible causes
First, good news: in the vast majority of cases, the cause is benign. No panic. But identifying the exact cause matters, because that's what determines the right treatment. Causes vary greatly by age — which is why the workup won't be the same at 20, 35 or 50.
In young women (under 30)
At this age, the first thing always to rule out is pregnancy — even if it seems impossible to you. Heavy, unusual bleeding can be the sign of an early pregnancy, a miscarriage, or an ectopic pregnancy. A simple urine test or blood test confirms it.
Then, two common causes worth checking:
- A clotting disorder. Some women — especially adolescents — have blood that clots less well. The best-known is von Willebrand disease, which affects 1 to 2 in 10 adolescents with very heavy periods. A blood test is all that's needed.
- Irregular ovulation. Very common around puberty or with polycystic ovary syndrome (PCOS). Without regular ovulation, the cycle "goes off track" and bleeding becomes unpredictable.
Between 30 and 45
This is the age when "structural" causes become common — meaning there's often something visible on ultrasound:
- The uterine fibroid. A small benign mass in the muscle of the uterus, like a nodule. Especially fibroids close to the uterine cavity (called submucosal) cause heavy bleeding. 2 to 4 women in 10 after age 35 have at least one.
- The polyp. A small benign growth attached to the inner wall of the uterus. Often painless but bleeds. More common after age 40.
- Adenomyosis. The inner lining of the uterus invites itself into its own muscle. Result: heavy and often painful periods, with a slightly enlarged uterus. Clearly seen on MRI.
- Endometriosis. Uterine lining tissue develops outside the uterus (ovaries, ligaments, bowel…). It doesn't always cause heavy periods, but it's often associated with very painful periods, with pelvic pain outside periods, and sometimes with difficulty conceiving.
After 45: perimenopause
The approach of menopause disrupts the hormonal cycle and can make periods completely unpredictable — sometimes close together, sometimes far apart, often heavy. This is very common and usually benign. But at this age, the appearance of the uterine lining should always be checked on ultrasound, sometimes with a biopsy, to rule out abnormal thickening.
And cancer? Worth mentioning, even if rare
Let's address this clearly, because the fear of cancer is often the first thing that comes to mind with abnormal bleeding. To be specific: in the vast majority of cases, it isn't cancer. But certain gynaecological cancers can present with bleeding, which is why they are systematically looked for, especially after 45:
- Endometrial cancer (of the uterine lining) — especially after 50, or with risk factors (overweight, diabetes, unbalanced hormonal treatment). Endometrial biopsy is the key test.
- Cervical cancer — much rarer thanks to smear test screening and the HPV vaccine. Bleeding after intercourse should raise this possibility.
- Vulvar and vaginal cancers — very rare, often in older women, but easily detected on gynaecological examination.
At any age: don't forget hormones and medications
Hypothyroidism (a slow-running thyroid) sometimes explains heavy periods on its own — and is easy to correct. Also think of medication side effects: the copper IUD, some anticoagulants, certain antidepressants, or an ill-suited hormonal contraceptive.
What tests will your doctor suggest?
The workup is simpler than people often think. In most cases, three things are enough at the start to understand what's happening.
The gynaecological exam in clinic
This is a complete and routine exam, never uncomfortable for more than a few minutes. It includes:
- Inspection of the vulva and examination of the vagina using a speculum.
- Inspection of the cervix, and depending on your follow-up, a smear test if it's not up to date.
- A bimanual pelvic exam to assess the size of the uterus and look for clues (enlarged uterus, mass, tenderness).
This exam reassures in the vast majority of cases, and already rules out a local cause (lesion of the cervix, vagina, or vulva).
A blood test
Three key results:
- Your haemoglobin and ferritin levels — to check whether you're anaemic.
- Your thyroid (TSH) — to rule out an easy-to-treat cause.
- If you're young or have always had heavy periods, a clotting test.
- In women of reproductive age, a pregnancy test is systematic.
A pelvic ultrasound
Transvaginal ultrasound is the reference exam. Painless, quick, it shows whether you have a fibroid, a polyp, signs of adenomyosis or endometriosis, or an ovarian cyst.
If needed, more thorough tests
Depending on the results, your doctor may suggest a pelvic MRI (useful for mapping multiple fibroids, or for visualising adenomyosis or endometriosis), a diagnostic hysteroscopy (a thin mini-camera that looks directly inside the uterus, in clinic, without anaesthesia), or an endometrial biopsy — a small sample of the uterine lining, especially recommended after age 45 or if the ultrasound shows something unusual.
When should you see a gynaecological surgeon?
Good news: in most cases, we start with medical treatments, and that's enough. Surgery is never the first reflex. But there are situations where seeing a gynaecological surgeon directly is the right move.
When you should consult a surgeon
- Medical treatments haven't worked after 3 to 6 months properly followed (hormonal IUD, anti-bleeding tablets, the pill, etc.).
- You can't tolerate the medical treatment — annoying side effects, breast tenderness, weight gain, low mood, poor IUD tolerance.
- Hormonal treatments are medically forbidden for you (history of phlebitis, migraine with aura, breast cancer, hypertension, etc.).
- Imaging shows something that surgery can treat: a bleeding fibroid, a polyp, a localised area of adenomyosis or endometriosis.
- You have a pregnancy plan with a fibroid that could interfere with conception or pregnancy.
- The anaemia is severe or your quality of life is heavily impacted.
- The workup found an abnormality of the uterine lining needing surgical verification (especially after 45).
When to consult urgently
Some situations can't wait — call your doctor the same day, or go to A&E:
- You've been changing protection every hour for more than 24 hours straight.
- You're very pale, breathless at rest, your heart racing, or you've fainted.
- You have severe pelvic pain, especially with fever.
- You have bleeding outside your periods, especially after 45 or after menopause.
In the practice, listening before proposing
A consultation for heavy periods always starts with a conversation: impact on daily life, medical history, pregnancy plans, treatments already tried. This is the time that allows the next step to be calibrated.
Further tests — ultrasound, blood tests, sometimes MRI or hysteroscopy — come afterwards, based on what you've described.
If surgery is needed: what are the options?
If surgery becomes the option to consider, know that you have several choices — and these are things discussed together in consultation. It all depends on the exact cause, on your life plans (planned pregnancy or not), and on your preferences. Here are the main options.
Option 1 — Procedures that keep the uterus intact
If the cause is identified (fibroid, polyp), it can often be treated without touching the rest of the uterus:
- Removal of a fibroid or polyp via the natural route (hysteroscopic resection). We go through the vagina, no external scar. You go home the same day. Back to your activities within a few days. Ideal for fibroids or polyps protruding into the uterine cavity.
- Removal of a fibroid by laparoscopy (laparoscopic myomectomy). Three or four small incisions of less than one centimetre on the abdomen. The uterus and fertility are preserved. Hospital stay of 1 to 2 days.
- Removal by open surgery (open myomectomy), reserved for very large or very numerous fibroids. Horizontal scar, 3 to 5 days in hospital.
Option 2 — Embolisation (without surgery)
This ingenious technique is performed by an interventional radiologist, not a surgeon. The principle: a fine tube is threaded through the artery in the groin, navigated up to the arteries that feed the fibroids, and their "supply" is cut. Deprived of blood, the fibroids shrink spontaneously.
- Particularly useful when there are several fibroids and we want to avoid open surgery.
- Hospital stay 24 to 48 h, back to usual activities within 7 to 14 days.
- Very effective on bleeding: about 9 women in 10 are relieved at one year.
- To be discussed carefully if you are still considering pregnancy.
Option 3 — Endometrectomy (removing the uterine lining)
Endometrectomy consists in removing the thin layer that lines the inside of the uterus — the one that bleeds during your periods. No more lining, no more periods (or infinitely lighter ones). A short procedure performed in theatre under general anaesthesia, as a day case (you go home the same day).
Concretely, the surgeon introduces a fine instrument through the natural pathways (hysteroscopy) and removes the lining with a small electrical loop. Alternative techniques exist with a thermal balloon or radiofrequency (such as NovaSure®, used by some surgeons — not by Dr Zeitoun, who performs loop resection).
- More than 8 women in 10 are very satisfied with the result at one year.
- Important: this technique prevents any future pregnancy. It is only offered to women who no longer wish to have children, and contraception must be continued until menopause.
Once the uterine lining is removed, pregnancy becomes very unlikely and dangerous (miscarriage, ectopic pregnancy, placentation complications). This technique is never offered to a woman who might still wish for pregnancy, even later.
Option 4 — Hysterectomy (removing the uterus)
This is the definitive option. The uterus is removed and that's it: never any periods again. This operation is still very common (it's one of the most performed gynaecological operations worldwide), but it is always discussed calmly, without haste. Three possible techniques:
- Vaginal route — no external scar. The fastest recovery. Suitable for medium-sized uteri.
- Laparoscopy — 3 or 4 small incisions. Recovery in 2 to 4 weeks.
- Open surgery — for very large uteri, horizontal scar.
Crucial point: the ovaries are almost always preserved in premenopausal women. This means you won't be put into menopause by the surgery. Your hormones continue to work normally. All details on the benign uterine surgery page.
Medical treatment, the first step
Before considering surgery, a medical treatment (tranexamic acid, anti-inflammatories, the pill, hormonal IUD) is almost always offered as first-line therapy for three to six months.
For many patients, this approach is enough to regain a good quality of life. If it doesn't work, or if the anatomical cause requires it, surgery then becomes an option to discuss together.
The money question: is it covered?
Good news: everything is covered by the French national health insurance — consultations, ultrasound, MRI, hysteroscopy, and all the procedures mentioned (myomectomy, endometrectomy, embolisation, hysterectomy). In case of severe chronic anaemia, an ALD 30 (long-term condition) request can be made, and cover becomes 100%.
Dr Zeitoun practises in sector 2 non-OPTAM: extra fees may apply, but your complementary health insurance may reimburse all or part of them depending on your policy. A detailed quote is always provided before any procedure, at the preoperative consultation. No procedure is scheduled without a written quote and a prior consultation. No bad surprises.
Let's discuss your situation
A consultation allows precise assessment of your options, including possible surgical management. Dr Zeitoun sees patients quickly in Paris or Neuilly-sur-Seine.
