Bleeding disorders and heavy periods

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

You can raise this even if you have grown used to planning life around heavy periods. A useful opening is: “My periods have always been heavy, and I also have bleeding in these other situations. Could they be connected?”

How clotting can affect periods

Von Willebrand disease, often shortened to VWD, is a condition in which blood does not clot properly. It involves von Willebrand factor, a protein that helps small blood cells called platelets stick together to form a clot. There may be too little of the protein, or it may not work as it should.

VWD is the most common bleeding disorder, but other conditions can also affect bleeding, including platelet function disorders. Most people with VWD inherit it. Occasionally it occurs without a known family history or is acquired later because of another health condition.

Other bleeding to mention

Mention frequent nosebleeds, bleeding gums, bruising easily or bleeding longer than expected after a cut. Bleeding after dental work, surgery or childbirth also matters. Some people have few symptoms until an injury or procedure reveals the problem.

Tell the clinician if a parent, sibling 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, including in people who do not have an inherited disorder.

For your periods, a short record of start and end dates, soaked products, leaks and the effect on daily life can help explain the problem. Include other bleeding episodes in the same note. Your clinician can help work out whether they share a cause.

Ask which blood tests are being arranged

A GP may examine bruising, ask about past bleeding and refer you to a haematologist, a specialist in blood conditions. VWD is assessed with blood tests, and repeated samples may be needed. The tests look at clotting proteins, checking how much is present and how well they work.

NICE recommends a full blood count for everyone with heavy menstrual bleeding, alongside treatment. Heavy bleeding can lead to anaemia, so ask whether both the effects of blood loss and a possible clotting disorder are being investigated.

Treatment can cover periods and other bleeding

Treatment depends on the type and severity of the disorder. For heavy periods, options include tranexamic acid and hormonal contraception, such as the combined pill or hormonal IUS. Other treatments for VWD include desmopressin or replacement clotting factor. Your specialist or pharmacist can explain the medicines and which are suitable.

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

Ask your specialist before surgery, dental treatment or a planned pregnancy, and tell anyone treating you that you have a bleeding disorder. Pregnancy and birth need a care plan. Also check painkillers and supplements with a pharmacist or doctor: medicines including aspirin and ibuprofen can increase bleeding problems. Do not stop a prescribed medicine without discussing it with 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. Do not wait for bleeding to continue for a set 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 cannot 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 stools are black or dark red.

Book a routine GP or doctor appointment for heavy periods affecting daily life, repeated nosebleeds, easy bruising or a close family history of VWD. Ask whether a haematology referral is needed and how to manage bleeding while investigations are under way.