Heavy periods care guide

Review care for regular, heavy periods online

For adults with regular but very heavy or long periods and a negative pregnancy test this cycle, after screening for concerns that need an exam first.

Start online

Start a $59 online review for Heavy menstrual bleeding.

Regular, heavy periods may fit online review after a safety check. The physician reviews your bleeding pattern and makes sure a blood count, ferritin test for iron stores, and pregnancy test are on file. Treatment depends on your results and history; some concerns need an in-person or gynecology visit first.

If treatment is appropriate, your physician can send a non-controlled prescription to your pharmacy and provide portal instructions for the next step.

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Quick facts

You must be physically located in Virginia or West Virginia at the time of request.
Starts at $59
No insurance needed
No app download
Physician review around the clock
Non-controlled prescriptions can be sent to your pharmacy when appropriate
A work or school note can be included when medically appropriate
Response times apply 24/7, every day

Common symptoms

Regular periods with very heavy flow
Periods lasting more than 7 days
Clots during heavy periods
Heavy periods with tiredness and a low iron level

May fit online care

Adults 18 and older
You are 18 or older with regular but very heavy or prolonged periods
You have a negative pregnancy test from this cycle
Your history has no features that need an examination first
Your blood count, ferritin, and pregnancy test can be reviewed or ordered if missing
If your age or history calls for it, a normal biopsy of the uterine lining is already on record

Look for another care setting

Soaking through a pad or tampon every hour for 2 or more hours in a row, dizziness, fainting, a racing heart or shortness of breath with the bleeding, or heavy bleeding with severe pelvic pain or a positive pregnancy test or possible pregnancy, or a known hemoglobin below 7 g/dL (emergency).
Possibly pregnant, or no pregnancy test this cycle.
Bleeding that started after menopause.
Bleeding between periods, after sex, or an irregular pattern with no predictable period.
Known fibroids, a pelvic mass, or pelvic pressure or bloating.
A past blood clot, stroke, blocked eye blood vessel, a condition that makes blood clot too easily (thrombophilia), or a heart valve or rhythm problem that raises clot risk. These mean no tranexamic acid and no estrogen-containing medicine.
A different bleeding problem (heavy periods since your first periods, easy bruising, frequent nosebleeds, heavy bleeding after a dental procedure, surgery, or childbirth, or a close relative with a bleeding problem) needs a hematology blood-disorder screen, not just a clotting-risk screen.
Bleeding that is new or clearly heavier in the last 6 months, severe anemia, or an earlier abnormal ultrasound, biopsy or gynecology finding also needs an in-person evaluation first.
Already using combined hormonal birth control (pill, patch or ring) or an IUD.
Age 45 or older, obesity, polycystic ovary syndrome or infrequent ovulation, estrogen without a progestin, Lynch syndrome, or heavy periods that have not improved with a prior medicine, without a normal endometrial biopsy on record. That is the endometrial evaluation the tranexamic acid label calls for before it is prescribed.
Tamoxifen use or a past endometrial cancer.
A known hemoglobin of 7 to 10 g/dL (urgent gynecology visit).
Periods that are not regular, or that you are not sure are regular, also need an in-person look first.
Chest pain, trouble breathing, swelling, pain or warmth in one leg, sudden vision loss or change, eye pain, or a severe headache with vision change, now or while taking tranexamic acid (emergency).

What to have ready

Your usual period pattern and any recent changes
Your pregnancy test result from this cycle
Blood count and ferritin results, if available
Any prior biopsy results and history of period treatments
A recent kidney blood test if you have kidney disease, diabetes, or high blood pressure

What happens next

Standard

$59

Within 6 hours

Priority

$99

Within 3 hours

Rush

$149

Within 1 hour

Start the request on the website, answer a few questions to check that this visit fits you, and choose how fast you want an answer (the response window). If your concern still fits this service, a physician reviews it and sends you a secure update after you sign in. When appropriate, non-controlled prescriptions can be sent to your pharmacy, and a basic work or school note can be included at physician discretion.

Your physician

Every visit is personally reviewed by Ankur Fadia, MD. He is board-certified, has extra training in heart care (a cardiology fellowship), and is a member of Alpha Omega Alpha, a medical honor society. He is licensed in Virginia and West Virginia, and your care is never handed off to someone else.

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What tests does the physician review first?

This practice starts by making sure a blood count, ferritin, and pregnancy test are on file and orders missing tests. A thyroid test is ordered only if you have symptoms of a thyroid problem.

What treatments can be considered for heavy periods?

Based on your history and test results, the doctor may consider tranexamic acid, an anti-inflammatory medicine (one that lowers swelling and pain), or a hormone option, plus iron if you have anemia (a low red blood cell count). If you have had a blood clot, or have a heart or blood condition that raises clot risk, you cannot get tranexamic acid or any medicine that contains estrogen through this option. You will need an in-person or gynecology (women's health) visit instead. A prescription is not guaranteed.

Do I need a biopsy before online treatment?

You need a normal endometrial biopsy (a test of the lining of the uterus) on record first if any of these apply: you are 45 or older, you have obesity or polycystic ovary syndrome (PCOS, a hormone condition), you use estrogen without a progestin (another hormone), you have Lynch syndrome (an inherited condition that raises cancer risk), or a past medicine did not help your heavy periods.

Can this visit handle new or irregular bleeding?

New or recently worse bleeding, irregular periods, bleeding between periods or after sex, and bleeding after menopause need an in-person or gynecology visit. This option is for regular, heavy periods after safety review.

Other conditions we treat

Not quite what you have? Here are other conditions we treat.

Birth control Bacterial vaginosis Combined birth control Delay your period Morning-after pill Menopause hormone therapy (systemic)