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What is usually behind heavy or painful bleeding

Not a list to diagnose yourself from — a list so that the conversation makes sense.

Lesson 3 of 5

12 min Text

What this lesson says

  • Fibroids and adenomyosis are common structural causes, and both are benign
  • Hormonal patterns including PCOS and thyroid disease can change bleeding
  • A contraceptive method, particularly a copper IUD, changes bleeding by design
  • Clotting differences and some medicines can make bleeding heavier
  • In a minority of cases heavy or irregular bleeding is the first sign of something that needs urgent assessment, which is why it is investigated rather than assumed

This is general education. It is not advice about your own situation, and it does not replace seeing a clinician.

Written lesson.
  1. 1. Heavy bleeding is a symptom, not a diagnosis, and a clinician is working through a short list of common explanations before a rarer one. Knowing the list is not so you can pick your own; it is so that the questions and the tests stop feeling random.
  2. 2. Structural causes are common and mostly benign. Fibroids are non-cancerous growths in the muscle of the womb, extremely common, and whether they cause heavy bleeding depends far more on where they sit than on how large they are. Adenomyosis, where the lining tissue grows into the muscle wall, typically causes heavy bleeding with a dragging, worsening pain; Indian ultrasound reports often describe it as a bulky uterus. Polyps are small benign growths in the lining that can cause bleeding between periods.
  3. 3. Hormonal patterns are the other large group. PCOS more often causes infrequent periods, but when a bleed finally comes after a long gap it can be very heavy. An under-active thyroid can make bleeding heavier and is easy to test for. The years approaching menopause change bleeding in almost everybody.
  4. 4. Then there is what you are already using or taking. A copper IUD makes periods heavier by design, particularly in the first months, and that is expected rather than a complication. Some hormonal methods cause unpredictable spotting while they settle. Blood-thinning medicines and some inherited differences in clotting make bleeding heavier — worth mentioning if heavy periods have been there since the very first one, or if nosebleeds and bruising run in the family.
  5. 5. More than one of these can be true at once, which is the commonest reason a single treatment only half works. And a small proportion of heavy or irregular bleeding is the first sign of a condition of the lining of the womb that needs prompt assessment. That possibility is not a reason to be frightened; it is the reason bleeding that has changed is investigated rather than reassured away, particularly bleeding between periods, after sex, or at any point after menopause.

All lessons in this course

  1. 1 What ordinary looks like, and how wide the range is 10 min
  2. 2 What counts as heavy, when nobody can measure it 10 min
  3. 3 What is usually behind heavy or painful bleeding 12 min Reading now
  4. 4 What gets checked, and why iron is in the first set of tests 11 min
  5. 5 What treatment is aimed at, and questions for your clinician 10 min

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