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If you are changing protection every hour or two, passing large clots, bleeding for more than seven days, flooding through to your clothes, or feeling constantly exhausted and breathless — that is heavy menstrual bleeding, and it is the leading cause of iron-deficiency anaemia in women in Bangladesh.
Irregular cycles — PCOS, thyroid disease, raised prolactin, stress and weight change, perimenopause, contraceptive effects. Heavy bleeding — fibroids, adenomyosis, polyps, endometrial hyperplasia, bleeding disorders, IUD effects, thyroid disease. Painful periods — endometriosis, adenomyosis, fibroids, pelvic infection, or primary dysmenorrhoea. Absent periods — pregnancy first, then PCOS, thyroid, prolactin, low body weight, excessive exercise, premature ovarian insufficiency. Bleeding between periods or after intercourse — always needs assessment; cervical causes must be excluded.
Any bleeding after menopause requires urgent assessment. Do not wait to see if it settles.
Pelvic ultrasound, complete blood count and ferritin, thyroid and hormone profile, cervical smear, endometrial biopsy where indicated, and hysteroscopy to look directly inside the uterine cavity for polyps or fibroids.
Medical: tranexamic acid, NSAIDs, combined or progesterone-only hormonal treatment, the hormonal IUD (highly effective for heavy bleeding and often avoids surgery altogether), iron replacement, and treatment of the underlying cause. Surgical: hysteroscopic polyp or fibroid removal, endometrial ablation, myomectomy, and hysterectomy as a last resort where family is complete and other options have failed.
