Small blood clots can be a normal part of a period, but passing clots larger than about 2.5 cm, changing your pad every 1 to 2 hours, or bleeding for more than 7 days are signs of heavy periods (haid banyak, or menorrhagia). Heavy periods are common and can be normal for some women, but they can also be caused by conditions such as fibroids or adenomyosis, and can lead to kurang darah (anaemia). This guide explains how to tell if your period berketul or heavy flow is normal, the main causes, treatment options and when to see a doctor.
Apa itu haid banyak (menorrhagia)?
Heavy menstrual bleeding, or menorrhagia, means losing a lot of blood during your period, or bleeding for longer than usual. Doctors also look at how much it affects your life: the UK's National Institute for Health and Care Excellence (NICE) tells doctors to recognise that heavy menstrual bleeding has a major impact on a woman's quality of life, and that treatment should aim to improve this rather than only reduce blood loss.
Heavy periods are common. Australia's government health service, healthdirect, says about 1 in 4 women have heavy periods. The NHS says they may be normal for you, and that periods can be heavier at certain times, such as when you first start your periods, after pregnancy or as you approach menopause (see our guide to menopaus). For many women with heavy periods, no cause is found.
Period normal vs haid banyak: how to tell
A typical period, according to the NHS, comes every 21 to 35 days and lasts 2 to 7 days, usually about 5 days. Bleeding is heaviest in the first 2 days, and most women lose about 20 to 90 ml of blood (about 1 to 5 tablespoons). Healthdirect adds that blood can range from bright red to dark brown, and that you may see small clots.
It is hard to measure blood loss at home, so health services use practical signs. Definitions vary a little:
| Sign of heavy periods | NHS (UK) | healthdirect (Australia) | ACOG (US) |
|---|---|---|---|
| How long it lasts | More than 7 days | More than 8 days | More than 7 days |
| How often you change pads | Every 1 to 2 hours | Every 1 to 2 hours, or overnight | Soaking 1 or more pads every hour for several hours in a row, or changing at night |
| Double protection | Needing 2 types together, such as a pad and a tampon | Using a towel on the bed or a maternity pad at night | Needing more than 1 pad at a time |
| Clots | Larger than about 2.5 cm | Larger than an Australian 50 cent coin | As big as a US quarter coin or larger |
| Leaks | Bleeding through to clothes or bedding | Bleeding through clothing | |
| Daily life | Avoiding activities such as exercise, or taking time off work | Not able to do things you normally would | |
| Other signs | Feeling tired or short of breath a lot | Feeling very tired, looking pale, being short of breath; losing more than 80 ml |
Darah period berketul: bila normal, bila perlu risau?
Some women notice clots in their period blood, and large, dark red clots are sometimes described as looking like pieces of chicken liver (berketul seperti hati ayam).
- Usually normal: small clots, especially on the heaviest days. Healthdirect says that during a normal period you may see small clots, and that blood can range from bright red to dark brown.
- A sign of heavy periods: clots larger than about 2.5 cm, according to the NHS. ACOG uses a similar size: clots as big as a US quarter coin or larger.
- See a doctor if: you often pass large clots, your periods have become heavier than before, or you have other signs from the table above.
Large clots on their own do not tell you the cause. A doctor can help find out why your periods are heavy.
Punca haid banyak (causes)
Healthdirect, the NHS and ACOG list several groups of causes:
| Group | Examples | Learn more |
|---|---|---|
| Conditions of the womb | Fibroids (non-cancerous growths in the womb muscle), polyps (growths in the womb lining), adenomyosis, endometriosis, a thickened womb lining (endometrial hyperplasia) | Fibroid, Adenomyosis, Endometriosis |
| Hormone changes | PCOS (now also called PMOS), an underactive thyroid, puberty, perimenopause, starting or changing hormonal medicines. When you do not ovulate regularly, the womb lining can become too thick, says ACOG | PCOS, Tiroid |
| Bleeding disorders | Von Willebrand disease (an inherited condition where blood takes longer to clot), platelet problems, low platelets | |
| Medicines and devices | Blood thinners (anticoagulants), aspirin, some chemotherapy medicines. The copper IUD can make periods heavier, especially in the first year | Pil perancang & IUD |
| Pregnancy-related | Miscarriage or ectopic pregnancy can cause heavy bleeding | Keguguran, Mengandung luar rahim |
| Infection | Pelvic inflammatory disease (PID) | |
| Rarely, cancer | Heavy periods can rarely be a sign of womb cancer. ACOG notes that most cases are diagnosed after menopause, in women in their mid-60s | Kanser rahim |
If your periods are also very painful, see our guide to senggugut. Fibroids and adenomyosis can cause both heavy and painful periods.
Haid banyak dan kurang darah (anaemia)
Losing a lot of blood every month can use up your body's iron and lead to iron deficiency anaemia. According to the NHS, symptoms can include:
- tiredness and lack of energy;
- shortness of breath;
- noticeable heartbeats (heart palpitations);
- paler skin than usual;
- headaches.
ACOG says severe anaemia can cause shortness of breath and increase the risk of heart problems. NICE recommends a full blood count blood test for all women with heavy menstrual bleeding. If you have iron deficiency anaemia, the NHS says iron tablets are usually taken for about 6 months once the cause has been found. Read more in our guide to kurang darah.
Heavy periods in Malaysia
- Anaemia is common in Malaysian women. According to the National Health and Morbidity Survey (NHMS) 2019, reported by the Health director-general, 3 out of 10 women aged 15 to 49 have anaemia.
- Few girls seek help. In a survey of 2,411 secondary schoolgirls in Negeri Sembilan, published in 2006, about 18% reported excessive menstrual blood loss (needing 2 pads at a time, or told by a doctor that they were anaemic because of heavy periods), but only 11.1% had seen a doctor for their period problems. Mothers were the main source of information about periods (80%).
The NHS advises seeing a doctor if heavy periods are affecting your life, so there is no need to put up with them in silence.
What happens when you see a doctor
A doctor will usually ask about:
- how long your periods last, how often you change pads, and whether you pass clots or bleed through clothes;
- other symptoms, such as bleeding between periods, pelvic pain or pressure;
- how your periods affect your life;
- your medicines, contraception and whether you could be pregnant.
Healthdirect and ACOG suggest keeping a period diary or app before your visit, noting when your period starts and stops and how heavy it is. Tests may include:
- a full blood count to check for anaemia, which NICE recommends for all women with heavy periods;
- a pregnancy test and sometimes tests for sexually transmitted infections;
- an ultrasound scan of the womb, or a hysteroscopy (a thin camera passed through the cervix to look inside the womb), if fibroids, polyps or other problems are suspected;
- tests for bleeding disorders, which NICE says should be considered if you have had heavy periods since your periods started and you or your family have a history of bleeding problems.
NICE advises doctors not to test female hormones for heavy periods, and not to test thyroid hormones unless you also have other signs of thyroid disease. If your symptoms suggest a low risk of fibroids or other womb problems, NICE says a doctor can consider starting treatment without first doing scans.
Rawatan haid banyak (treatment)
The NHS says heavy periods do not always need to be treated, but treatment can help if they are affecting your daily life. The right choice depends on the cause, your age, your health and whether you want to get pregnant.
| Treatment | What it is | Things to know |
|---|---|---|
| Hormonal coil (IUS) | A small T-shaped device in the womb that releases progestogen | NICE recommends considering it as the first treatment for heavy periods with no cause found, fibroids smaller than 3 cm, or adenomyosis |
| Tranexamic acid | A non-hormonal tablet that reduces bleeding | ACOG says it is taken each month at the start of your period |
| Anti-inflammatory painkillers (NSAIDs) | Such as mefenamic acid or naproxen | Can reduce bleeding and period pain (ACOG) |
| Combined pill | Hormonal contraception containing oestrogen and progestogen | ACOG says hormonal birth control can make periods lighter and more regular. Not suitable for everyone (see our pil perancang guide) |
| Progestogen tablets | Taken for part of each cycle | NICE lists cyclical oral progestogens as an option. Progestogen-only contraception may also stop periods, which can help |
| Iron tablets | To treat iron deficiency anaemia | Healthdirect says your doctor may recommend iron supplements or an iron infusion if your iron is low |
| Endometrial ablation | A procedure that removes or destroys the womb lining | Stops or reduces bleeding. ACOG says pregnancy is not likely afterwards but can happen and is risky, so contraception is still needed |
| Fibroid treatments | Removing fibroids (myomectomy or hysteroscopy) or blocking their blood supply (uterine artery embolisation) | Used when fibroids are causing heavy bleeding (NICE, ACOG) |
| Hysterectomy | Removing the womb | Stops periods permanently, and you can no longer get pregnant. Usually considered when other treatments have not worked |
The NHS says that if treatments from a GP do not work, or a condition may be causing your heavy periods, you will usually be referred for tests or to a specialist (gynaecologist).
Cara mengatasi haid banyak at home
Healthdirect suggests some practical steps while you wait for or have treatment:
- Use extra protection on heavy days, such as a menstrual cup or tampon with a pad or period underwear.
- Keep a period kit at work or school: fresh underwear, pads, a plastic bag and a change of clothes.
- Look after your general health: eat a balanced diet, get enough sleep, exercise regularly, manage stress and keep a healthy weight.
- Track your periods in a diary or app, and take it to your appointment.
These steps help you cope, but they do not treat the cause. See a doctor if heavy periods continue.
When to see a doctor or get urgent help
The NHS advises seeing a doctor if:
- heavy periods are affecting your life;
- you have had heavy periods for some time;
- you have severe pain during your periods;
- you bleed between periods or after sex;
- you have heavy periods and other symptoms, such as pain when peeing, pooing or having sex.
Healthdirect also advises seeing a doctor if you have bleeding after menopause.
Get urgent help at a hospital emergency department (the emergency number in Malaysia is 999) if:
- your bleeding is suddenly much heavier than usual;
- you have a heavy period with signs of anaemia, such as dizziness or weakness (healthdirect);
- you have abnormal vaginal bleeding (healthdirect), including heavy bleeding when you might be pregnant, which ACOG says can be caused by a miscarriage or ectopic pregnancy (see our guide to mengandung luar rahim).
Frequently asked questions (FAQ)
Darah haid berketul normal ke (are period clots normal)?
Small clots can be a normal part of a period, especially on the heaviest days. According to the NHS, passing blood clots larger than about 2.5 cm is one sign of heavy periods. See a doctor if you often pass large clots, if your periods are heavier than before, or if they affect your daily life.
Berapa banyak darah haid yang normal (how much blood loss is normal)?
The NHS says most women lose about 20 to 90 ml of blood (about 1 to 5 tablespoons) during a period, which usually lasts about 5 days and is heaviest in the first 2 days. Australian health guidance describes losing more than 80 ml in a period as heavy. Doctors also ask how often you change pads and how your periods affect your life.
Kenapa darah period berketul seperti hati ayam (why do clots look like chicken liver)?
Large, dark red clots that look like pieces of liver are not a diagnosis in themselves, but clots larger than about 2.5 cm are one of the signs of heavy periods listed by the NHS. Heavy periods can be normal for some women, but they can also be caused by conditions such as fibroids, adenomyosis, endometriosis or polyps, so it is worth seeing a doctor.
Apa punca haid banyak (what causes heavy periods)?
Causes include conditions of the womb or ovaries such as fibroids, polyps, adenomyosis, endometriosis and PCOS (now also called PMOS), hormone changes such as an underactive thyroid, puberty or perimenopause, bleeding disorders such as von Willebrand disease, and some medicines such as blood thinners. The copper IUD can also make periods heavier. Rarely, heavy periods can be a sign of womb cancer. For many women, no cause is found.
Can heavy periods cause anaemia (kurang darah)?
Yes. Losing a lot of blood every month can lead to iron deficiency anaemia, which can cause tiredness, shortness of breath, heart palpitations, pale skin and headaches. NICE recommends a full blood count test for all women with heavy menstrual bleeding. In Malaysia, the National Health and Morbidity Survey 2019 found that 3 in 10 women aged 15 to 49 had anaemia.
Bagaimana cara mengatasi haid banyak (how are heavy periods treated)?
Heavy periods do not always need treatment. If they affect your life, a doctor may offer the hormonal coil (IUS), which NICE recommends considering first for many women, or tranexamic acid, anti-inflammatory painkillers, the combined pill or progestogen tablets. If medicines do not help or a cause such as fibroids is found, specialist options include endometrial ablation, removing fibroids or, as a last option, a hysterectomy.
When should I go to the emergency department for heavy bleeding?
Get urgent care if your bleeding is suddenly much heavier than usual, or if you have heavy bleeding with signs of anaemia such as dizziness or weakness. If you might be pregnant, heavy bleeding can be caused by a miscarriage or ectopic pregnancy, so get checked urgently. Go to a hospital emergency department; the emergency number in Malaysia is 999.
Disclaimer
This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor. Health supplements are not intended to diagnose, treat, cure or prevent any disease.
References
- Heavy periods — NHS
- Periods — NHS
- Iron deficiency anaemia — NHS
- Fibroids — NHS
- Heavy periods — healthdirect (Australian Government)
- Menstruation (periods) — healthdirect (Australian Government)
- Heavy menstrual bleeding — American College of Obstetricians and Gynecologists (ACOG)
- Heavy menstrual bleeding: assessment and management (NG88), Recommendations — NICE
- Lee LK, Chen PC, Lee KK, Kaur J. Menstruation among adolescent girls in Malaysia: a cross-sectional school survey. Singapore Med J. 2006;47(10):869-74.
- One in five Malaysians suffer from anaemia — Dr Noor Hisham — Bernama (26 July 2021)
