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Women's health

Heavy and painful periods – when it stops being normal

Bleeding that soaks through hourly, or pain that stops you working, is not something to endure. What causes it and what treats it.

The threshold nobody tells you

There is no official cup measurement anyone can apply at home. The practical definition is impact: bleeding that affects your life is heavy, whatever the volume.

  • Soaking through a pad or tampon every hour or two.
  • Needing double protection, or getting up at night to change.
  • Passing clots larger than a coin.
  • Flooding through clothing or bedding.
  • Periods lasting more than seven days.
  • Planning your life around your period, or missing work or school.
  • Symptoms of anaemia: tiredness, breathlessness, dizziness.

Similarly with pain: cramping that responds to a painkiller and lets you carry on is ordinary. Pain that stops you functioning, does not respond to painkillers, or has worsened over time is not, and it should not be met with 'periods are like that'.

What causes it

  • Fibroids — benign muscular growths in the womb, common and a frequent cause of heavy bleeding and pressure symptoms.
  • Adenomyosis — womb lining growing into the muscle wall, causing heavy, painful periods and a bulky uterus.
  • Endometriosis — tissue like the womb lining growing outside it. Pain typically starts before the bleeding and can involve the bowel or bladder.
  • Hormonal patterns, particularly in the years after starting periods and in perimenopause.
  • A copper coil, which commonly increases bleeding.
  • Thyroid problems and bleeding disorders — the latter often missed in someone who has bled heavily since her very first period.
  • Polyps, infection, and rarely cancer of the womb lining.

Treatments that work

Options in South Africa, from least to most involved:

  • Mefenamic Acid — Ponstan, Adco-Mefenamic, Mefac, Ponstel

    Dysmenorrhoea; mild to moderate pain; menorrhagia

  • Ibuprofen — Nurofen, Brufen, Advil, Ibupain

    Mild to moderate pain; inflammation; fever; dysmenorrhoea

  • Tranexamic Acid — Cyklokapron, Hexakapron

    Menorrhagia; post-partum haemorrhage; trauma-related bleeding; dental extraction bleeding

  • Levonorgestrel / Ethinylestradiol (Combined OCP) — Ovral, Nordette, Triphasil, Yasmin (drospirenone/EE)

    Contraception; menstrual regulation; dysmenorrhoea; acne

  • Levonorgestrel Intrauterine Device — Mirena

    Long-acting reversible contraception (up to 5 years); heavy menstrual bleeding; endometrial protection during HRT

  • Norethisterone (Progestogen-only pill) — Microval, Noriday

    Contraception — suitable for breastfeeding women and those who cannot use oestrogen

  • Anti-inflammatories reduce both pain and bleeding, and work best started just before or as bleeding begins rather than once it is heavy.
  • Tranexamic acid reduces bleeding substantially and is taken only on heavy days. It is not hormonal and does not affect fertility.
  • The hormonal coil is the single most effective medical treatment for heavy periods and often reduces bleeding dramatically — many women stop bleeding altogether.
  • The combined pill regulates and lightens periods and helps pain.
  • Iron replacement, because the anaemia needs treating in its own right.
  • Surgical options exist for fibroids and for bleeding that does not respond, and hysterectomy is a last resort rather than a first suggestion.

When to be seen sooner

Common questions

Is it normal to pass clots?
Small clots are common. Repeatedly passing clots bigger than a coin, or flooding, points to heavy bleeding worth treating — particularly if you are also tired or breathless, which suggests anaemia.
Will treatment affect my fertility later?
None of the standard medical treatments cause lasting infertility. Hormonal methods are reversible, and tranexamic acid and anti-inflammatories are not hormonal at all. Untreated endometriosis, by contrast, can affect fertility — which is an argument for investigating rather than waiting.
I have bled heavily since my first period. Is that just me?
Possibly, but heavy bleeding from the very first period is the classic history for an inherited bleeding disorder, which is under-diagnosed in women. It is worth mentioning specifically, because it changes what gets tested.

Sources

Last reviewed 4 August 2026.