Heavy periods, known by the medical term of menorrhagia, are a common cause of moderate anaemia in pre-menopausal women who have no other symptoms. But it's essential to see your doctor to get the cause of your anaemia properly established, as it could be because of a variety of things that may need urgent treatment.

Often no specific cause for menorrhagia

Menorrhagia often gets progressively more severe until you reach the menopause. Although no specific cause can be found in many cases, it's important to rule out the possible causes of heavy bleeding. Your doctor will be able to assess the situation and explain the options.

To start with, it's important to get some idea of just how much blood you're losing. This can be hard to gauge, but signs of particular heavy periods include:

• flooding - when you suddenly lose a large amount of blood
• the loss of clots of blood
• needing to change your sanitary wear during the night

Your doctor will want to establish whether you have regular cycles (irregular cycles may settle down with hormonal treatment) and if there are any signs of other conditions, such as bleeding at other times in your menstrual cycle or bleeding after sex.

In particular, your doctor will want to check for special risk factors that might suggest a cancer of the womb, polycystic ovarian syndrome (POS) or a history of treatment with oestrogen drugs.

Treating heavy periods

Once a remedial cause for heavy periods has been ruled out, the options for treating it are usually:

• Non-hormonal treatments: these include drugs such as mefenamic acid or tranexamic acid, but they're not suitable for all woman and they may cause side effects.
• The contraceptive pill: the combined oestrogen/progestogen pill may be suggested, and can control cycles and reduce bleeding.
• Mirena: this is a type of intrauterine device which slowly releases the hormone levonorgestrel. It can reduce blood loss by 80 per cent to 90 per cent (many women say their periods stop completely), although it may cause a lot of irregular continuous bleeding for the first few weeks.

If none of these measures are suitable for controlling your bleeding your doctor may refer you to a gynaecologist. The options then include more powerful drugs or invasive treatments such as endometrial ablation or hysterectomy.

Treating anaemia itself

Although heavy periods may well be the cause of your anaemia, your doctor will probably ask you a variety of questions to check for other common causes of anaemia. She may also recommend further investigations such as checking the urine or faeces for blood loss from the gut or urinary system, or testing for causes of anaemia other than blood loss. (This may involve a simple blood test to check the exact pattern of anaemia that you have.)

If you have iron-deficiency anaemia, whatever the cause, your doctor will probably suggest treatment with iron tablets. There are several different types and if you don’t get on with one treatment do go back to your doctor and discuss the problem, as they may switch you to another type.

This article was last medically reviewed by Dr Trisha Macnair in August 2008