Bleeding disorders and heavy periods

If your periods have been heavy from the start, ask about a bleeding disorder. This matters even more if you also get nosebleeds or bruise easily. NICE recommends considering clotting tests when periods have been heavy since they started and your personal or family history suggests a clotting problem.

You can bring this up even if you’ve got used to planning your life around heavy periods. You could start with: “My periods have always been heavy, and I also bleed a lot in other situations. Could these be connected?”

How clotting can affect periods

Von Willebrand disease (VWD) is a condition where blood doesn’t clot properly. It involves von Willebrand factor, a protein that helps tiny blood cells called platelets stick together to form a clot. There may be too little of this protein, or it may not work as it should.

VWD is the most common bleeding disorder. Other conditions can also affect bleeding, including problems with how platelets work. Most people with VWD inherit it. Now and then it happens with no known family history, or it develops later in life because of another health condition.

Other bleeding to mention

Mention frequent nosebleeds, bleeding gums, bruising easily, or bleeding for longer than expected after a cut. Bleeding after dental work, surgery or giving birth matters too. Some people have few symptoms until an injury or a procedure shows up the problem.

Tell the clinician if a parent, brother, sister or child has VWD, or if relatives have a history of heavy bleeding. Bring your medicine list too. Some medicines can cause bleeding or make it worse, even in people who don’t have an inherited disorder.

For your periods, keep a short record of start and end dates, how many products you soak through, any leaks and how it affects daily life. This can help explain the problem. Add any other bleeding to the same record. Your clinician can help work out whether they have the same cause.

Ask which blood tests are being arranged

A GP may look at any bruising, ask about past bleeding and refer you to a haematologist (a specialist in blood conditions). VWD is checked with blood tests, and you may need to give more than one sample. The tests look at how much of the clotting proteins you have and how well they work.

NICE recommends a full blood count for everyone with heavy periods, alongside treatment. Heavy bleeding can lead to anaemia (too few red blood cells). So ask whether they’re checking for both the effects of losing blood and a possible clotting disorder.

Treatment can cover periods and other bleeding

Treatment depends on the type of disorder and how severe it is. For heavy periods, options include tranexamic acid and hormonal contraception, such as the combined pill or the hormonal coil (IUS). Other treatments for VWD include desmopressin or replacing the missing clotting factor. Your specialist or pharmacist can explain the medicines and which suit you.

With milder VWD, you may only need treatment for more serious bleeding or before a procedure. More severe VWD can need regular treatment to prevent bleeding. Ask for a written plan that says which team to contact and what to tell other clinicians about your condition.

Ask your specialist before surgery, dental treatment or a planned pregnancy. Tell anyone treating you that you have a bleeding disorder. Pregnancy and birth need a care plan. Check painkillers and supplements with a pharmacist or doctor too. Medicines such as aspirin and ibuprofen can make bleeding problems worse. Don’t stop a prescribed medicine without talking to your prescriber.

When to get help for bleeding

Call 999 now (UK) or 911 (US), or your local emergency number, if very heavy vaginal bleeding comes with chest pain, breathlessness and marked dizziness or lightheadedness. Don’t wait for the bleeding to go on for a certain time before getting emergency help.

Go to A&E now (UK), or the nearest emergency department (US or elsewhere), if an injury or cut is bleeding and you can’t stop it, or a nosebleed is very heavy or lasts longer than 10 to 15 minutes.

Contact an urgent GP service or NHS 111 today (UK), or your doctor or urgent care service (US or elsewhere), if vaginal bleeding makes you weak or lightheaded without the emergency symptoms above, you have blood in your urine, or your poo is black or dark red.

Book a routine GP or doctor appointment for heavy periods that affect daily life, frequent nosebleeds, bruising easily or a close family history of VWD. Ask whether you need to see a blood specialist and how to manage bleeding while you wait for tests.