Menstrual health
Menorrhagia: understanding heavy periods
Menorrhagia affects nearly one in five women.
Causes, symptoms, diagnosis and treatments: everything you need to understand to take action and stop suffering.
- Updated in 2025
- Reading time: 9 min
- Medically verified content
What is menorrhagia?
Menorrhagia refers to abnormally heavy or prolonged periods, without bleeding between cycles. It is clinically defined as menorrhagia when menstrual loss exceeds 80 ml per cycle and/or when periods last more than 7 days.
In practice, measuring the exact volume at home is impossible. This is precisely why the Higham score was developed: a simple tool that allows the abundance of flow to be objectively assessed without medical equipment, with a clinical threshold set at 100 points per cycle.
Menorrhagia is one of the most common gynaecological complaints and one of the leading reasons for gynaecology consultations. Yet many women normalise it for years, due to the lack of a reference tool.
Recognising the symptoms
Beyond the volume of blood lost, menorrhagia manifests through a range of signs that are important to identify:
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Frequently saturated protection
Having to change protection several times a day over several consecutive days is a warning sign.
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Large clots
The presence of clots larger than one centimetre is characteristic of a particularly heavy flow.
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Intense fatigue
Abnormal fatigue during or after periods may indicate anaemia related to blood loss.
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Prolonged periods
Periods lasting more than 7 days, even if the flow is not excessively heavy, deserve attention.
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Necessary night-time protection
Getting up at night to change protection or finding leaks on the sheets is a sign of excessive flow.
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Impact on daily activities
Avoiding certain activities, planning your days around your period or taking time off work are important warning signs.
Do you recognise these symptoms?
Calculate your Higham score to objectively assess your flow.
The most common causes
1
Uterine fibroids
Benign tumours of the uterus, very common (30 to 40% of women). Depending on their location, they can significantly increase menstrual flow.
2
Endometriosis
Presence of endometrial tissue outside the uterus. Associated with painful and sometimes heavy periods, often under-diagnosed for years.
3
Adenomyosis
Invasion of the uterine muscle by endometrial cells. Causes very heavy and painful periods, particularly after the age of 35.
4
Coagulation disorders
Certain conditions such as von Willebrand disease can cause heavy periods from puberty. Often overlooked as a potential cause.
5
Hormonal imbalances
An imbalance between oestrogen and progesterone (common in perimenopause) can lead to thickening of the endometrium and heavier periods.
6
Copper coil (IUD)
The copper IUD is a common and reversible cause of heavy periods, and can increase flow by 20 to 50% in some women.
7
Polyps & fibroids of the uterus
Excroissances bénignes qui se développent sur la paroi interne de l’utérus. Leur présence modifie la structure de l’endomètre, ce qui entraîne fréquemment des saignements prolongés et abondants.
The role of the Higham score in diagnosis
When menorrhagia is suspected, the doctor relies on several elements: the patient history, clinical examination, laboratory tests (FBC, ferritin, coagulation screen) and imaging (pelvic ultrasound, MRI).
The Higham score plays an essential role in this process: it objectively quantifies the patient’s experience with a reproducible figure. Bringing a score diary to an appointment can help speed up diagnosis and guide further investigations.
Treatment options
Treatment depends on the identified cause, the severity of symptoms, the desire for pregnancy and the patient’s preferences. The available options range from medical treatment to surgery:
Medical treatment
First line
Progestogens & hormonal contraceptives
Combined pills, the hormonal IUD (Mirena) or progestogens in the second half of the cycle significantly reduce flow. This is frequently the first option proposed.
Medical treatment
as needed
Tranexamic acid
An antifibrinolytic taken during periods, it reduces bleeding by 30 to 50% without affecting hormones. Useful when hormonal contraception is contraindicated.
Surgical treatment
conservative
Endometrial ablation
Destruction of the uterine lining by day surgery. Reduces or permanently eliminates periods in 80% of cases. Not suitable for women wishing to become pregnant.
Surgical treatment
radical
Hysterectomy
Removal of the uterus, reserved for severe cases resistant to other treatments. A permanent solution resulting in permanent sterility. A decision carefully considered with the surgeon.
Better daily living
While awaiting treatment or alongside it, certain everyday adaptations can comfortably improve your quality of life during your period.
Discover our practical tips, recommendations for suitable protection and products that can make a real difference day to day:
Tips, products and advice for living better with heavy periods
📱 Calculate your score
Record your protection use day by day. The app calculates your score in real time and generates a PDF report for your doctor.