Heavy menstrual bleeding

For a lay person:

Heavy menstrual bleeding (menorrhagia) is periods heavy or long enough to interfere with daily life: soaking through pads or tampons every hour or two, passing large clots, or bleeding for more than seven days. Over time it can cause anaemia.

For a trained medical person:

Assess using the PALM-COEIN classification: structural causes (polyp, adenomyosis, leiomyoma, malignancy or hyperplasia) and non-structural ones (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic). Check a full blood count; consider coagulation studies and imaging. Treatment includes the levonorgestrel IUS, tranexamic acid, NSAIDs and hormonal options.

In Chinese medicine:

Classed as excessive menstruation (月經過多). Bright, profuse bleeding is read as Blood Heat or Damp-Heat; pale, watery bleeding as Spleen Qi or Kidney Deficiency failing to hold the Blood; dark, clotted bleeding with pain as Blood Stasis.

When to get help: Get emergency care for very heavy bleeding with dizziness or fainting. Any bleeding after menopause needs prompt assessment.