Dr. E. Prashanthi Reddy
MBBS · DGO · Diploma in ART — Kiel University, Germany
Founder & Medical Director — Mother Hospitals & IVF Center, Boduppal
TGMC Registration: 50624 · 19+ Years of Clinical Experience · 5000+ IVF Cycles
Soaking a pad every 1–2 hours, passing clots, periods lasting 7+ days — expert diagnosis and targeted treatment. Fibroids, adenomyosis, polyps, hormonal causes. Dr. E. Prashanthi Reddy, Boduppal.
Heavy menstrual bleeding is defined clinically as blood loss exceeding 80ml per cycle — but practically, it means bleeding that significantly impacts your daily life.
Chronic heavy menstrual blood loss leads to iron-deficiency anaemia — causing persistent fatigue, breathlessness on exertion, dizziness, poor concentration, and reduced immunity. Many women normalise these symptoms without realising they are directly caused by blood loss. Anaemia from menorrhagia is entirely treatable once the underlying cause is identified.
Heavy menstrual bleeding affects approximately 1 in 3 women at some point in their reproductive life. It is the most common reason women under 50 are referred to gynaecology, and one of the leading causes of iron-deficiency anaemia in Indian women. Despite being so common, many women endure years of heavy bleeding unnecessarily — effective treatments are available for every cause.
See a gynaecologist if you have any of the symptoms above, if your periods are heavier than they used to be, if you have new clots or prolonged bleeding, if you are trying to conceive and have heavy periods, or if you feel persistently tired and breathless — even when not on your period. Early diagnosis means faster relief.
Identifying the specific cause of your heavy bleeding directs the most effective treatment. There is always a reason — and always a solution.
The most common structural cause. Submucosal fibroids (inside the uterine cavity) cause the heaviest bleeding. Fibroids are benign muscle tumours and are extremely common — affecting up to 70% of women by age 50. Treatment ranges from medication to laparoscopic myomectomy.
Endometrial tissue grows into the muscular uterine wall (myometrium), causing the uterus to enlarge, swell during periods, and bleed heavily. Often associated with severe period pain. Diagnosed on ultrasound and MRI. Often underdiagnosed — and Dr. Prashanthi is experienced in its recognition and management.
Small benign growths on the lining of the uterus that cause heavy, irregular, or intermenstrual (between-period) bleeding. Diagnosed by hysteroscopy or saline sonography. Easily removed during hysteroscopy, and symptoms resolve rapidly post-removal.
PCOS with anovulatory cycles (where ovulation does not occur regularly) leads to an unstable, thickened endometrial lining that sheds irregularly and heavily. Treated with hormonal regulation or ovulation induction depending on whether conception is desired.
Hypothyroidism (underactive thyroid) is a commonly missed cause of heavy periods. Low thyroid hormone affects oestrogen metabolism and raises prolactin, causing heavy, prolonged cycles. A simple TSH blood test diagnoses this — and treatment with levothyroxine rapidly restores normal periods.
Von Willebrand disease (the most common inherited bleeding disorder in women) is significantly underdiagnosed as a cause of heavy periods — affecting up to 13% of women with menorrhagia. Diagnosed with a coagulation screen. Managed with tranexamic acid and specialist haematology input when needed.
A systematic approach ensures no cause is missed. Most investigations can be arranged at the first consultation.
The first step — assessing for anaemia (low haemoglobin), iron deficiency (low serum ferritin and iron, raised TIBC), and platelet count. Anaemia confirms that bleeding is clinically significant and directs iron supplementation or transfusion planning if needed.
TSH and thyroid function (to exclude thyroid cause), FSH and LH (to assess ovarian function and exclude anovulatory cause), progesterone (to confirm ovulation), and in younger women, a coagulation screen (PT, APTT, von Willebrand factor antigen and activity) to exclude bleeding disorders.
The essential first-line imaging investigation. Transvaginal ultrasound provides detailed assessment of uterine size, uterine wall (adenomyosis), the uterine cavity (submucosal fibroids, polyps), and ovaries. Also assesses endometrial thickness. A 3D ultrasound or saline infusion sonography (SIS) provides additional detail of the uterine cavity.
The gold standard investigation for the inside of the uterus. A thin camera is passed through the cervix under direct vision. It identifies polyps, submucosal fibroids, and endometrial abnormalities that ultrasound may miss. Operative hysteroscopy treats the pathology at the same time — removing polyps or fibroids without an external incision.
From tablets to minimally invasive surgery — treatment is tailored to the cause, your symptoms, and whether you wish to preserve fertility.
Tranexamic acid (reduces blood loss by 25–40% — taken during the heavy days of the period), mefenamic acid and other NSAIDs (reduce prostaglandins that cause heavy bleeding and period pain). These are first-line options while investigation is underway and for women who need immediate symptom relief.
Combined oral contraceptive pills regulate the menstrual cycle and significantly reduce blood loss. Cyclic progesterone (norethisterone) taken in the second half of the cycle reduces endometrial growth and bleeding. Suitable for women without contraindications to hormonal treatment.
The Mirena IUS (levonorgestrel-releasing intrauterine system) is one of the most effective non-surgical treatments for heavy menstrual bleeding — reducing blood loss by 80–90% within 3–6 months. Inserted as an outpatient procedure. Suitable for women who do not need immediate fertility and are willing to use hormonal contraception. Also highly effective for adenomyosis.
Polyps and submucosal fibroids are removed under light anaesthesia using a hysteroscope (camera inserted through the cervix — no external incisions). Recovery is rapid (1–2 days). This is the most effective treatment for bleeding caused by intrauterine pathology, with cure rates exceeding 90% for polyps.
For intramural fibroids (within the uterine muscle wall) causing heavy bleeding, a keyhole (laparoscopic) myomectomy removes the fibroid while preserving the uterus. This is the preferred fertility-preserving surgical option for women who wish to conceive. Recovery is typically 2–3 weeks.
A procedure that destroys the uterine lining to prevent heavy bleeding. Highly effective — approximately 80% of women have significantly reduced or absent periods. Not suitable for women who wish to conceive (as the uterine lining is destroyed) — this option is for women who have completed their family and want to avoid hysterectomy.
Removal of the uterus — the definitive treatment for heavy bleeding and the only 100% permanent cure. Reserved for women who have completed their family, have failed other treatments, or have significant pathology (large fibroids, severe adenomyosis). Performed laparoscopically where possible for faster recovery and smaller incisions.
MBBS · DGO · Diploma in ART — Kiel University, Germany
Founder & Medical Director — Mother Hospitals & IVF Center, Boduppal
TGMC Registration: 50624 · 19+ Years of Clinical Experience · 5000+ IVF Cycles
Common questions about heavy menstrual bleeding, fibroids, adenomyosis, and treatment options.
Clinically heavy bleeding is defined as soaking a pad or tampon every 1–2 hours for several consecutive hours, needing to use both pad and tampon at the same time, passing clots larger than a 50 paise coin, periods lasting more than 7 days, needing to change protection during the night, or if heavy bleeding is interfering with daily life or causing you to avoid activities. Iron-deficiency anaemia (fatigue, breathlessness, dizziness) is a common sign of chronic heavy blood loss — do not dismiss persistent tiredness as 'just stress'.
Uterine fibroids are the most common structural cause of heavy menstrual bleeding, particularly submucosal fibroids that distort the uterine cavity. Adenomyosis (endometrial tissue growing into the uterine muscle) is the second most common cause and is frequently underdiagnosed. Hormonal imbalance from anovulatory PCOS cycles is another common cause — where the endometrial lining thickens without regular shedding and then bleeds heavily.
The Mirena IUS (levonorgestrel-releasing intrauterine system) is one of the most effective treatments for heavy menstrual bleeding — it reduces blood loss by 80–90% in most women within 3–6 months. It is a hormonal coil (not a contraceptive coil containing copper) that is inserted in the clinic. It works locally on the uterine lining and is suitable for women who do not want surgery and are willing to use it as a form of hormonal contraception. It is also used as a fertility-preserving option in adenomyosis and is considered a first-line treatment for many women with heavy periods.
Adenomyosis occurs when the inner lining of the uterus (endometrium) grows into the muscular wall of the uterus (myometrium). This causes the uterus to enlarge and leads to heavy, prolonged, and painful periods. The uterus becomes boggy and enlarged — sometimes significantly so. The diagnosis is suspected on ultrasound and confirmed on MRI. Treatment options include the Mirena IUS (which reduces bleeding by suppressing the lining locally), GnRH agonists to temporarily shrink the uterus, or — for women who have completed their family — hysterectomy as a definitive cure.
Yes, in many cases. Medical options include tranexamic acid (reduces blood loss by 25–40%), mefenamic acid (reduces prostaglandins causing heavy bleeding), combined oral contraceptive pills, cyclic progesterone, and the Mirena IUS. The Mirena IUS is particularly effective and is often recommended as the first-line treatment for heavy periods when the woman does not want surgery and does not have large fibroids. Surgery is considered when medical treatments fail or when a structural cause (fibroid, polyp) is identified that is best addressed surgically.
Abnormal uterine bleeding should always be investigated, but the vast majority of cases — especially in women under 45 — are caused by benign (non-cancerous) conditions such as fibroids, polyps, adenomyosis, or hormonal imbalance. Endometrial cancer (cancer of the uterine lining) is rare before menopause and more commonly presents with bleeding after menopause or between periods rather than heavy periods. Dr. Prashanthi will investigate appropriately, including endometrial biopsy if clinically indicated, to rule out any serious underlying cause.
Hysteroscopy is the gold standard for investigating the inside of the uterus. A thin telescope is passed through the cervix into the uterine cavity, allowing direct visualisation of the endometrium (lining), polyps, submucosal fibroids, or any abnormal areas. Diagnostic hysteroscopy can be performed as an outpatient procedure under local or light anaesthesia. Operative hysteroscopy — where treatment is performed at the same time, such as polyp or fibroid removal — is performed under light general anaesthesia. It is far more accurate than ultrasound alone for identifying small lesions inside the uterine cavity.
Untreated chronic heavy menstrual bleeding leads to iron-deficiency anaemia, causing persistent fatigue, breathlessness, poor concentration, and reduced immunity. Over time, the underlying cause (fibroids, adenomyosis) may grow and become progressively harder to treat. In women trying to conceive, submucosal fibroids and polyps can prevent implantation and reduce IVF success rates. Heavy bleeding significantly reduces quality of life. Most women feel dramatically better — physically and emotionally — after appropriate treatment. Please do not normalise heavy periods as 'just the way you are'.
Explore other specialist services at Mother Hospitals & IVF Center.
Heavy periods are not something you have to live with. Dr. E. Prashanthi Reddy will identify the exact cause of your bleeding and provide targeted treatment — from tablets to minimally invasive surgery, always preserving your fertility where possible.
Dr. E. Prashanthi Reddy · TGMC Reg: 50624