Heavy Periods in London 2026. What Counts as Heavy, What Causes It and the Treatment NICE Puts First
Heavy menstrual bleeding affects around 1 in 3 women of reproductive age, and the most useful thing to know is that no measurement defines it. NICE guideline NG88 deliberately defines heavy periods as excessive menstrual blood loss that interferes with a woman's physical, emotional, social or material quality of life, which means your experience is the diagnosis and nobody should be asking you to count pads to justify treatment.
Key points
Practical markers of heavy bleeding are flooding through clothing or bedding, clots larger than a 10 pence piece, changing protection every hour or 2, or bleeding beyond 7 days.
Fibroids, present in up to 70% of women by 50, and adenomyosis, which is substantially under-diagnosed, are the commonest structural causes.
Ferritin below 30 means depleted iron stores even when the full blood count reads normal, which is why so many women with heavy periods are exhausted despite being told their bloods are fine.
The hormonal coil is NICE's first-line medical treatment and is frequently never offered before surgery is discussed.
Want your heavy periods properly assessed? Message a GMC-registered doctor on WhatsApp or email team@thewellnesslondon.com.
What is causing it
Fibroids are the commonest structural cause. They are benign growths of the muscle of the womb, present in up to 70% of women by the age of 50 and more common and often larger in women of Black African and Caribbean family background. Whether they cause heavy bleeding depends less on size than on position, since those distorting the cavity cause the most bleeding while others cause none at all.
Adenomyosis is the one most often missed. Endometrial tissue grows into the muscular wall of the womb, causing heavy bleeding with significant period pain and a bulky tender uterus. It is diagnosed on ultrasound by an experienced operator or on MRI, and a considerable number of women carry it for years labelled as having painful periods.
Endometrial polyps cause bleeding between periods as well as heavy periods. Copper coils increase bleeding, which is worth reviewing rather than enduring. Bleeding disorders, most commonly von Willebrand disease, account for a meaningful proportion of women with heavy periods since their first one, particularly where there is a family history or easy bruising and nosebleeds.
Thyroid disease in either direction affects the cycle. Polycystic ovary syndrome causes irregular rather than typically heavy periods, though prolonged gaps can be followed by heavy bleeds. And in perimenopause, cycles commonly become heavier and less predictable as ovulation becomes erratic, which is normal and still treatable.
Endometrial cancer and hyperplasia are uncommon but must be excluded in the right circumstances, which the next section covers.
When it needs urgent assessment
Bleeding after the menopause, meaning any bleeding 12 months or more after periods stopped, needs urgent assessment under the NICE guideline NG12 cancer pathway regardless of how light it is.
Bleeding between periods or after sex, particularly persisting, needs examination and assessment rather than reassurance, since it points at the cervix, a polyp or the endometrium.
Heavy bleeding with dizziness, breathlessness at rest, chest pain or fainting needs same-day assessment, because significant anaemia can develop quickly.
Age matters for the endometrium. NICE recommends considering endometrial biopsy in women aged 45 and over whose heavy bleeding persists despite treatment, or who have bleeding between periods, and sooner where there are risk factors including a body mass index over 30, polycystic ovary syndrome, tamoxifen use, diabetes or a family history of endometrial or bowel cancer through Lynch syndrome.
A rapidly enlarging pelvic mass, persistent bloating, early fullness or pelvic pain on most days for 3 weeks or more warrants CA125 and pelvic ultrasound under the ovarian pathway.
Not sure what should be checked? Ask on WhatsApp or email team@thewellnesslondon.com.
Why your iron matters more than you think
This is the part most often skipped and it explains a great deal of how women with heavy periods actually feel. Menstrual blood loss is the commonest cause of iron deficiency in women of reproductive age, and the symptoms arrive long before anaemia does.
Ferritin measures iron stores. Below 30 means those stores are depleted, and symptoms are common below 50, while haemoglobin and the full blood count can remain entirely normal. A report stating no anaemia therefore does not exclude iron deficiency, and a great many women are told their bloods are fine while running on empty.
The symptoms are exactly those people attribute to a busy life. Persistent fatigue, breathlessness on stairs, poor concentration, hair shedding, brittle nails, cold hands and feet, headaches and restless legs, where the relevant ferritin threshold is higher again at around 75.
Correcting it properly means an adequate dose for long enough, commonly 3 months beyond normalisation to refill stores, taken on alternate days with vitamin C and away from tea, coffee, calcium and antacids, which improves absorption considerably. Where oral iron fails, is not tolerated or correction is needed quickly, an iron infusion restores stores in 1 or 2 appointments.
And critically, treating the bleeding and treating the iron are 2 separate jobs. Doing only one leaves the woman either tired or still bleeding.
What treatment actually works
The hormonal coil is first-line medical treatment in NICE guideline NG88 and reduces menstrual blood loss substantially, frequently to spotting or nothing, while also providing contraception and, later, endometrial protection with HRT. It is fitted in a few minutes, lasts years, and a striking number of women referred for surgery have never been offered it.
Where a coil is not wanted or not suitable, tranexamic acid taken during bleeding reduces loss meaningfully and contains no hormones. Non-steroidal anti-inflammatories reduce both bleeding and pain. The combined pill regulates and lightens cycles. Cyclical progestogens have a narrower role than their frequent use suggests.
Where fibroids are the problem and are distorting the cavity, or are large, treatment options widen to include hysteroscopic removal of submucosal fibroids, uterine artery embolisation, myomectomy which preserves the womb, and newer medical treatments. Polyps are removed hysteroscopically as a day case. Endometrial ablation is an option for women who have completed their family.
Hysterectomy remains definitive and is the right choice for some women, but NICE is clear it should follow, not precede, the less invasive options, and being offered it first is a reason to seek another opinion.
Where we are
Portman Square, Marylebone
The Wellness is at 10 Portman Square, London W1H 6AZ, adjacent to Harley Street and 3 minutes from Baker Street.
Belgravia
Our second clinic is at the Light Centre, 9 Eccleston Street, London SW1W 9LX, close to Victoria.
What assessment costs
Consultant gynaecology appointments in the Harley Street district run £250 to £500 for a first consultation, with scans and hysteroscopy charged separately. Private pelvic ultrasound is billed per region, reaching around £415 at some central London hospitals before consultation and reporting. Outpatient hysteroscopy runs £1,200 to £2,500 and hysterectomy £9,000 to £16,000. Coil fitting across London sexual and women's health clinics runs £350 to £700.
At The Wellness the assessment, the imaging coordination and the treatment sit in one pathway. All figures are from prices.
Executive Health Programme, the most comprehensive assessment with full biomarker profiling and coordinated imaging, from £11,995.
Women's Body Scan programme with pelvic, breast and thyroid imaging, full bloods and review, from £3,495.
Iron infusion with diagnosis, investigation of the cause and follow-up testing, from £1,095, or from £895 where the diagnosis is established.
Pelvic ultrasound with assessment, consultant radiologist reporting and review, from £995.
Hormonal or copper coil fitting including pre-fitting assessment, the device, local anaesthetic, the procedure and the 6-week check, from £595.
Comprehensive Blood Panel including full blood count, ferritin and full iron studies, thyroid with antibodies and hormonal markers, with consultation and interpretation, from £495.
Extended 45-minute consultation covering bleeding, contraception and perimenopause together, from £395.
In-person consultation with examination, from £220. Same-day video consultation from £150. Mini consultation from £59.
Hysteroscopy, endometrial biopsy, MRI and gynaecology referral to a named consultant arranged with the appointment booked.
Appointments within the week at 10 Portman Square, Marylebone.
Ask what your plan would cost. Message us on WhatsApp.
Why The Wellness is the best place in London for heavy periods
Because you are believed. NICE defines heavy bleeding by its effect on your life rather than by a measured volume, so nobody here will ask you to justify the problem before treating it.
Because the iron is treated alongside the bleeding. Ferritin is measured rather than haemoglobin alone, depleted stores are corrected properly with an adequate dose for long enough, and an iron infusion is available where oral iron has failed. That single addition changes how most women with heavy periods feel within weeks.
Because the first-line treatment is actually offered. The hormonal coil is fitted here, within days, at £595 including the assessment, the device, local anaesthetic and the follow-up check, rather than mentioned and left to arrange elsewhere.
Because imaging is arranged where it changes the plan, at the specialist centre best equipped for pelvic work with consultant radiologist reporting, which is what identifies adenomyosis and locates fibroids accurately enough to decide treatment.
And because the cancer pathway is applied properly. Postmenopausal bleeding, bleeding between periods and persistent bloating are escalated rather than watched, and endometrial biopsy is considered from 45 where bleeding persists despite treatment.
Related reading
Coil fitting and contraception covers the procedure in detail, iron infusion covers intravenous iron, private menopause care covers perimenopausal bleeding changes, bloating, IBS and reflux covers persistent bloating as an ovarian pathway symptom, and private ultrasound scans explains how pelvic imaging is arranged.
Book an assessment. Message us on WhatsApp, email team@thewellnesslondon.com, or call +44 20 3951 3429.
Frequently asked questions about heavy periods
What counts as a heavy period?
NICE guideline NG88 defines it as excessive menstrual blood loss interfering with your physical, emotional, social or material quality of life, with no measurement required. Practical markers are flooding through clothing or bedding, clots larger than a 10 pence piece, changing protection every hour or 2, or bleeding beyond 7 days.
What causes heavy periods?
Fibroids, present in up to 70% of women by 50, and adenomyosis, which is substantially under-diagnosed, are the commonest structural causes. Endometrial polyps, copper coils, bleeding disorders such as von Willebrand disease, thyroid disease and perimenopause all contribute.
What is the best treatment for heavy periods?
The hormonal coil is first-line medical treatment in NICE NG88 and reduces blood loss substantially, often to spotting or nothing. Alternatives include tranexamic acid, non-steroidal anti-inflammatories and the combined pill. Hysterectomy should follow rather than precede less invasive options.
Why am I so tired with heavy periods?
Almost certainly iron deficiency. Menstrual loss is the commonest cause in women of reproductive age, and ferritin below 30 means depleted stores while the full blood count can read normal.
Do I need a scan for heavy periods?
Not always, but pelvic ultrasound is arranged where fibroids or adenomyosis are suspected, where examination is abnormal, or where treatment has not worked, and is what identifies adenomyosis and locates fibroids accurately enough to decide treatment.
This article is for information and does not replace personal medical advice. Heavy bleeding with dizziness, breathlessness at rest or fainting needs urgent assessment, and in an emergency call 999. All treatments at The Wellness are performed by GMC-registered doctors. Reviewed by [GMC-REGISTERED DOCTOR NAME, GMC NUMBER TO CONFIRM], The Wellness. Last updated September 2026.
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