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Heavy Menstrual Bleeding (Menorrhagia)
If you regularly soak through pads or tampons, pass large blood clots, or feel fatigued, you could be suffering from menorrhagia. While many women tolerate heavy periods for years, it should not be considered normal.
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At Daniel Koh Clinic, we investigate why menorrhagia occurs and offer personalised, evidence-based treatment. From medical therapy to surgical procedures, we manage symptoms of menorrhagia and aim to restore your quality of life.
What Is Heavy Menstrual Bleeding (Menorrhagia)?​​​
Heavy menstrual bleeding, also known as menorrhagia, refers to periods that are unusually heavy and/or prolonged. It can lead to excessive blood loss, disrupt daily life, and sometimes signal a serious gynaecological issue.
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In the past, menorrhagia was defined as losing more than 80 ml of blood per cycle. Today, any period that causes anaemia, requires changing sanitary pads/tampons every 1 to 2 hours, or interferes with work, school or social life should be investigated by a gynaecologist.
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A typical menstrual period can last up to seven days. It should not soak more than two pads within an hour or force you to change protection during the night. Excessive bleeding can appear at any reproductive age, but is seen most often just after the first periods begin and in the forties.
Common Symptoms of Heavy Menstrual Bleeding (Menorrhagia)​
If you experience any of the following, you may have heavy menstrual bleeding:
Excessive Bleeding
You soak through two or more pads or tampons within an hour, need to double-up protection, or notice “flooding” that forces you to change clothes or bedding.
Large Blood Clots
You pass clots larger than 2cm. This signals that blood is pooling in the vagina before it can be passed out.
Frequent Changing of Menstrual Products
If you need to set alarms to change protection at night, carry spare sanitary supplies with you everywhere, or restrict travel due to issues with toilet access, then your flow is heavier than usual.
Anaemia
Ongoing blood loss lowers iron stores and haemoglobin levels. Anaemia can present as fatigue, shortness of breath on mild exertion and dizziness.
Pelvic Pain
The womb contracts harder to expel a thick endometrial lining and blood clots, leading to pelvic cramps. The pain is often worse on days with heavy menstrual flow.
Disruption of Daily Life
Heavy menstrual flow can disrupt your daily life. When menstruation regularly forces you to reorganise activities or stay near a bathroom, it is time to seek medical advice.
What Causes Heavy Menstrual Bleeding (Menorrhagia)?
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​Hormonal imbalance: When oestrogen and progesterone are out of synchronisation, the womb’s lining grows thicker than usual, resulting in heavier menstrual flow during menstruation.
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Benign growths inside the womb: Fibroids and polyps enlarge and/or distort the womb’s cavity, resulting in a larger surface area and heavier bleeding each cycle.
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Clotting disorders: Conditions such as von Willebrand disease slow the blood-clotting process, resulting in heavier and prolonged bleeding.
Other factors that may contribute to heavy menstrual bleeding include:
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Age: Heavy bleeding is common in the first few years after periods start and in the forties.
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Medication: Blood thinners and some hormonal therapies can result in heavy, prolonged menstruation.
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Intra-uterine device (IUD): The copper coil is associated with heavier or prolonged menstrual flow for the first few cycles from the time of insertion.
How is Heavy Menstrual Bleeding (Menorrhagia) Diagnosed?
Your gynaecologist will take a detailed medical history and conduct laboratory and radiological investigations to diagnose menorrhagia and identify any potential underlying cause.
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You may be asked:
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Cycle pattern: How often it comes, how long is the duration and whether you bleed in between cycles.
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Volume pattern: Number of soaked pads or tampons, presence of blood clots, need for double protection or night changes.
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Anaemia symptoms: Whether you experience any tiredness, breathlessness, dizziness and/or reduced exercise tolerance.
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Pain pattern: Where cramps are felt, how strong they are and which days they are at their worst.
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Medication review: If you take any blood thinners, hormone pills, or utilise medical devices such as a copper IUD.
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Personal and family history: Whether you or close relatives have thyroid disease, bleeding disorders, fibroids or cancer.
You may be offered the following Investigations:
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Full blood count and iron studies to check for anaemia.
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Thyroid and coagulation screen when hormone or clotting issues are suspected.
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Pelvic ultrasound to look for fibroids and polyps inside the cavity of the womb or adenomyosis.
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Hysteroscopy to obtain tissue for diagnostic purposes and to rule out pre-cancerous or cancerous changes.
Heavy Menstrual Bleeding (Menorrhagia) Treatment Options in Singapore
Treatment for menorrhagia can be individualised by your age, plans for pregnancy and the extent to which the bleeding affects your quality of life.
Lifestyle and Nutritional Support
Maintaining a healthy weight/body mass index, managing stress, exercising regularly and eating iron-rich foods support medical treatment and may lessen symptoms over time.
Iron Supplements
Heavy bleeding can deplete iron stores and lower haemoglobin levels. Oral iron supplementation or an intravenous iron infusion can help restore iron stores and improve energy levels when iron levels are low.
Non-Hormonal Medications
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Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce blood loss by up to 35% and also ease period pain.
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Tranexamic acid slows down the rate of bleeding by forming clots.
Hormonal Therapy
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Low-dose combined hormonal pills (contraceptive pills)
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Progestin tablets or depot injections
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Levonorgestrel intra-uterine system to thin the uterine lining
Hysteroscopy, Dilation and Curettage (D&C)
Under anaesthesia, the cervix is dilated and a scope with a camera attached is inserted into the womb to assess the inside of the womb. A thin layer of the inner lining is then removed or suctioned. D&C can stop acute heavy bleeding and also provide tissue for laboratory testing. For more information on D&C, read our previous blog article.
Endometrial Ablation
A device emitting heat, radiofrequency waves or laser energy is inserted into the womb to reduce the womb’s lining. Period flow may become lighter or stop altogether.
Uterine Fibroid Removal (Myomectomy)
Hysteroscopic, laparoscopic (keyhole) or open pelvic surgery can be performed to remove fibroids that cause menorrhagia. This option is suitable for women who wish to preserve fertility or avoid a hysterectomy.
Hysterectomy
The uterus, and usually the cervix, is surgically removed. This surgery is reserved for situations where all treatments have failed and women who have no more plans for children.
​Why Early Heavy Menstrual Bleeding (Menorrhagia) Treatment Matters
If left untreated, heavy periods can lead to:
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Severe anaemia and fatigue
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Worsening of underlying conditions such as fibroids, polyps, adenomyosis, endometritis or cancer of the cervix, womb or ovaries.
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Reduced fertility potential: Long-term blood loss, infection, or untreated uterine disease can make it harder to conceive or carry a pregnancy successfully.
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Delayed diagnosis of more serious conditions (e.g. uterine cancer)
When Is Hysteroscopy, D&C Necessary?
Your specialist may perform a diagnostic hysteroscopy to determine the cause of abnormal bleeding. Hysteroscopy allows your specialist to see the inside of the womb to diagnose fibroids, polyps or suspicious lining. Tissue is sampled to exclude serious conditions such as womb cancer.
Is D&C a permanent solution?
D&C clears the thickened lining and often reduces bleeding for several cycles. However, it does not remove underlying problems such as fibroids that are not in the womb’s cavity, adenomyosis or hormonal imbalance. Ongoing management, such as through medication, hormonal devices or surgery, may still be required.
About Dr Daniel Koh
Dr Daniel Koh
Consultant Obstetrician & Gynaecologist
BMBS (AUS), M.MED (O&G, SG), FRCOG (UK), FAMS (SG)
Dr Daniel Koh is a senior obstetrician and gynaecologist based at Gleneagles Medical Centre, with extensive experience in treating menstrual disorders, including menorrhagia.
He offers:
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Detailed evaluation
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Personalised treatment plans for women of all ages
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Empathy in a confidential, non-judgmental setting
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Expertise in both medical and surgical treatments for abnormal bleeding
Whether you are newly experiencing symptoms or dealing with persistent heavy menstrual flow, Dr Koh will guide you through your options with professionalism and empathy.
Frequently Asked Questions (FAQ)
Below are concise answers to questions women often ask about heavy periods and their treatments. For personalised professional advice, book an appointment with our gynaecologist, Dr Daniel Koh.
