Heavy menstrual bleeding is treated by first finding the cause, usually with a pelvic ultrasound and blood tests, and then choosing a treatment that fits your symptoms and pregnancy plans. Options include non-hormonal medication such as tranexamic acid, hormonal pills, the hormonal IUD, removal of polyps or fibroids, endometrial ablation and, rarely, hysterectomy.
- Common causes
- Polyps, fibroids, adenomyosis, hormones
- Tests
- Ultrasound, blood count, hormones
- First-line
- Medication or hormonal IUD
- Procedures
- Hysteroscopy, ablation
- Fertility
- Most options preserve it
- Seen by
- Dr. Sun-Ok Lee; surgery with Dr. Jung-Ho Seo
What causes heavy menstrual bleeding?
Heavy menstrual bleeding (sometimes called menorrhagia) means periods heavy or long enough to affect your daily life. If you are still unsure whether your bleeding counts as heavy, start with our self-check guide: is my period too heavy?
Doctors group the causes into structural and non-structural ones:
- Structural — endometrial polyps, uterine fibroids, adenomyosis, and rarely precancerous changes of the lining.
- Hormonal / ovulatory — irregular ovulation (for example with PCOS, thyroid disease or around perimenopause), which allows the lining to overgrow.
- Bleeding disorders — such as von Willebrand disease, especially if periods have been heavy since your first period.
- Medications and devices — blood thinners and, in some women, the copper IUD.
How is heavy bleeding diagnosed?
- Consultation in English Your doctor asks how many days you bleed, how often you change pads or tampons, clots, flooding, and symptoms of anemia such as tiredness or breathlessness.
- Pregnancy test Pregnancy-related bleeding is ruled out first.
- Transvaginal ultrasound A pelvic ultrasound on the same day measures the lining and looks for polyps, fibroids or adenomyosis.
- Blood tests A complete blood count and iron studies check for anemia; thyroid, hormone or clotting tests are added when indicated.
- Endometrial biopsy or hysteroscopy if needed Recommended when the lining looks abnormal, bleeding is persistent, or there are risk factors such as age over about 45.
Treatment options compared
| Option | How it works | Good to know |
|---|---|---|
| Tranexamic acid | Non-hormonal tablet that reduces bleeding, taken only during the period | Does not prevent pregnancy; not suitable for some clotting risks |
| Anti-inflammatory painkillers (NSAIDs) | Reduce blood loss and cramps | Modest effect; take with food |
| Combined pill or progestin tablets | Thin the lining and regulate cycles | Also contraceptive; not for everyone |
| Hormonal (levonorgestrel) IUD | Releases progestin directly into the uterus | Often greatly reduces bleeding; lasts several years — see IUD insertion |
| Hysteroscopic polyp or fibroid removal | Removes the structural cause through the cervix | No skin incisions; keeps fertility |
| Endometrial ablation | Destroys the lining to reduce bleeding | Only for women who have completed childbearing |
| Hysterectomy | Removes the uterus | Permanent; considered when other options fail |
Iron supplements are often prescribed alongside treatment if blood tests show iron deficiency.
An overgrown uterine lining can cause heavy, prolonged periods and iron-deficiency anemia.
Treatment aims to thin or remove the excess lining so that periods become lighter.
Choosing what fits you
Your gynecologist will discuss the options in English, considering:
- Pregnancy plans — if you want children in the future, ablation and hysterectomy are not appropriate.
- Need for contraception — the hormonal IUD or pill can treat bleeding and prevent pregnancy at the same time.
- The cause found on ultrasound — polyps and submucosal fibroids are often best removed with hysteroscopy.
- Your time in Korea — if you are here briefly, a plan that can be continued by your home doctor is prepared, with English reports.
When is heavy bleeding an emergency?
Most heavy periods are not dangerous, but ongoing blood loss can cause iron-deficiency anemia. Book a check-up if heavy periods are new, getting worse, or leave you tired and short of breath.
Cost and insurance for international patients
Costs depend on whether you need only tests and medication or a procedure. As a general guide, consultations are about ₩50,000–100,000; hysteroscopic myomectomy about ₩2M–5M and endometrial ablation about ₩2.5M–6M. A written estimate is given after consultation. NHI-enrolled residents are usually covered for medically necessary care — see health insurance for foreigners — and travelers can request English receipts and diagnoses for claims.
Why international patients choose Yoonho
Frequently asked questions
Do I have to have surgery for heavy periods?
No. Most women are treated first with medication or a hormonal IUD. Procedures are considered when a polyp or fibroid is found, or when other treatments have not helped.
Will the hormonal IUD stop my periods completely?
Many users find periods become much lighter, and some stop bleeding altogether after several months. Irregular spotting is common in the first three to six months.
Can heavy periods cause anemia?
Yes. Losing more blood than your body can replace leads to iron deficiency, causing tiredness, breathlessness and hair thinning. A simple blood test checks this, and iron supplements can help.
Can I start treatment in Seoul and continue it at home?
Yes. Treatments such as tranexamic acid, hormonal pills and the IUD are widely used internationally. You receive English reports and prescription details for your home doctor.
Is heavy bleeding a sign of cancer?
Usually not, but abnormal bleeding after about age 45, bleeding between periods or after menopause should be checked so that precancerous changes of the lining can be ruled out.
OB-GYN Specialist · Director of OB-GYN
M.D., Ewha Womans University College of Medicine · Former Clinical Instructor, Ewha Womans University Mokdong Hospital · Member, Korean Society of Menopause
Last reviewed: . This page is for general information and does not replace an in-person consultation.
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