Heavy periods

Periods that are heavier than they used to be, or heavier than you can comfortably manage. Doctors call it heavy menstrual bleeding, or menorrhagia.

In perimenopause, the years before your last period, periods change. The NHS website says they may come more or less often and the bleeding may get heavier or lighter.

The NHS website lists the signs. You may be changing your pad every hour or two. You need a pad and something else together. Your period runs past a week. You pass clots. You bleed through to your clothes or the bedding. You skip things, a wedding, a dawat, a day at work, because of your period. You feel tired or out of breath a lot.

In Urdu, women often measure it by the pad: aik ghante mein pad bhar jaye. That detail, how fast the pad fills, is exactly what a doctor needs to hear.

The NHS website says periods can be heavier at certain times of life, including the run-up to menopause, and that heavy periods can simply be normal for some women.

It also lists other causes worth ruling out: fibroids, endometriosis, adenomyosis, polyendocrine metabolic ovarian syndrome (the newer name for PCOS), pelvic inflammatory disease, conditions that make you bleed more easily, and some medicines, including some blood thinners. Rarely, the NHS says, heavy periods can be a sign of womb cancer.

That list is why the Pakistan Menopause Society asks doctors to investigate abnormal bleeding instead of assuming it is menopause. Perimenopause can explain heavy periods. It does not explain every heavy period.

• The NHS website says heavy periods do not always need treating, and that you may have blood tests to look for an underlying problem such as iron deficiency anaemia.
• The Pakistan Menopause Society asks doctors to document the bleeding pattern at the first visit and at follow-up (Tables 1 and 4). A record you kept yourself, through symptom tracking, makes that conversation much easier.

The NHS website lists treatments a GP may offer: some types of contraception, such as the hormonal coil (IUS) or the combined pill; tranexamic acid, a medicine that reduces bleeding; and prescription anti-inflammatory painkillers. If those do not work, or a condition might be behind it, a GP refers you for tests or to a specialist. Specialist options include removing the womb lining, removing fibroids, or a hysterectomy.

One line from the NHS menopause page matters at this age: the combined pill is not recommended from 50, because the risks generally outweigh the benefits. Which option suits you is your doctor's call, made with your age, your health and your plans in mind.

The NHS website says to see a GP if heavy periods are affecting your life, if you have had them for some time, if you have severe pain with your period, if you bleed between periods or after sex, or if heavy periods come with pain when peeing, pooing or having sex.

See a doctor promptly if the bleeding is sudden and heavy, or goes on far longer than usual. The Pakistan Menopause Society lists both among its red flags (section 2.3).

When periods turn heavy and unpredictable, the questions are not only medical. Which days count as a period? When does prayer start again? What about fasting, and wudu when bleeding does not stop? Women ask these and rarely get a straight answer. They belong with a qualified scholar. Roshara does not rule on them.

At home, heavy bleeding often gets hidden: an extra trip to the bathroom, a dark shalwar, saying you are tired. If you plan around your period every month, that is worth a proper conversation with a doctor.