Heavy Periods With PCOS? Here’s How to Rule Out Fibroids, Endometriosis and Other Causes

Understanding PCOS and Heavy Periods: How to Rule Out Conditions Like Fibroids and Endometriosis

Heavy periods can be exhausting; physically, mentally and emotionally.

If you’ve ever felt like you’re planning your entire life around your cycle, worrying about leaks, needing to stay close to a bathroom, or feeling completely wiped out during your bleed… you’re not alone.

And while PCOS can absolutely contribute to heavy or irregular periods, it’s not the only cause.

This is where women often get stuck :They’re told heavy bleeding is “just hormones” or “just PCOS”… but no one investigates further.

The truth is: Heavy periods deserve to be properly assessed, especially if they’re new, worsening, or affecting your daily life.

Because conditions like fibroids, endometriosis and adenomyosis can also cause heavy bleeding and they need different types of treatment and support.

Flower petals in underware

What Is PCOS and How Can It Cause Heavy Periods?

PCOS (Polycystic Ovary Syndrome) is a hormonal and metabolic condition that often affects ovulation.

When ovulation doesn’t happen regularly, progesterone remains low and estrogen stimulation continues, which can cause the uterine lining to keep building.

That means instead of the lining shedding consistently each month, it can become thickened and unstable, leading to:

• irregular bleeding

• unpredictable cycles

• prolonged bleeds

• heavy bleeds when the lining finally sheds

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This is one of the reasons women with PCOS can experience heavy periods.

But it’s important to note: PCOS heavy bleeding is usually linked to irregular or absent ovulation. So it often comes with irregular cycles, long gaps between periods, or unpredictable timing.

Why You Must Rule Out Other Causes of Heavy Bleeding

Heavy bleeding is not exclusive to PCOS.

In fact, some women have PCOS and heavy bleeding for a completely separate reason, which can easily be missed if everything is blamed on PCOS.

The most common conditions to rule out include:

1) Uterine Fibroids

Fibroids are non-cancerous growths in the uterus and are very common — particularly in women in their 30s and 40s.

Fibroids can cause:

• heavy or prolonged periods

• clotting

• pelvic pressure or heaviness

• back pain

• constipation

• frequent urination

Unlike PCOS, fibroids are structural (a physical growth), which means they can often be identified on imaging such as ultrasound.

2) Endometriosis

Endometriosis is an inflammatory condition where tissue similar to the uterine lining grows outside the uterus.

This condition can contribute to heavy periods, but it is particularly linked with pain, such as:

• painful periods (often severe)

• pain during ovulation

• pain with bowel movements during your bleed

• pain with sex

• fatigue and inflammation

Endometriosis can be more difficult to detect because it doesn’t always show clearly on ultrasound. Diagnosis may require specialist assessment and sometimes laparoscopy.

3) Adenomyosis

Adenomyosis is when the uterine lining grows into the muscle wall of the uterus, often leading to:

• heavy bleeding

• clotting

• painful periods

• pelvic heaviness

• fatigue

This is another commonly missed cause of heavy bleeds — especially if pain is also present.

Signs Your Heavy Periods Need Further Investigation

It’s time to investigate further if you experience:

• bleeding lasting longer than 7 days

• soaking through pads/tampons every 1–2 hours

• passing large clots

• needing to wake overnight to change protection

• severe pain or pelvic pressure

• fatigue, dizziness, shortness of breath (possible anaemia)

• heavy bleeding that has worsened over time

You do not have to tolerate this as “normal.”

How Doctors Diagnose the Cause of Heavy Periods

Proper assessment usually involves several steps:

1) Medical history + symptom patterns

A good practitioner will ask about:

• timing of your cycles

• volume of bleeding

• pain patterns

• clots

• ovulation symptoms

• other PCOS signs (acne, hair changes, weight changes)

This helps identify whether the pattern fits PCOS ovulation dysfunction or suggests a structural/inflammatory cause.

2) Physical exam

A pelvic exam can sometimes detect:

• uterine enlargement

• tenderness

• fibroid changes

3) Blood tests

To explore PCOS-related drivers and rule out other causes, testing may include:

• LH and FSH

• testosterone/free testosterone + SHBG

• prolactin

• thyroid markers

• fasting insulin + glucose markers

And importantly:

• iron studies + ferritin (to check for anaemia)

4) Imaging

Ultrasound is often the first step.

It can help assess:

• fibroids

• endometrial thickness

• ovarian appearance (PCOS features)

In some cases, further imaging such as MRI may be recommended, especially when adenomyosis is suspected.

5) Further investigation

If endometriosis is suspected, further assessment may include:

• specialist referral

• advanced imaging

• laparoscopy

Treatment Options Depend on the Cause

This is why diagnosis matters, because treatment should match the driver.

PCOS-related heavy periods

Support usually focuses on:

• regulating ovulation

• improving insulin resistance

• restoring progesterone patterns

• supporting hormone balance

This can include:

• lifestyle changes and nutrition

• medications like metformin (when appropriate)

• hormonal support if needed

Fibroids

Treatment may include:

• medications to reduce bleeding

• procedures or surgery depending on severity and fertility goals

Endometriosis / Adenomyosis

Management may include:

• inflammation support

• pain strategies

• hormonal therapies

• surgery when indicated

How I Help Naturopathically

Even while investigation is happening (or while you’re waiting for specialists), naturopathic care can be incredibly supportive.

I help women with heavy periods by:

• supporting further investigation (so you’re not dismissed)

• reducing inflammation

• balancing blood sugar and insulin resistance

• supporting hormone balance and ovulation

• addressing iron deficiency and nutrient depletion

• using personalised nutrition, herbs and supplements based on your symptom picture and testing

The goal isn’t just to cope, it’s to feel better and get your body functioning more smoothly.

Final Thoughts

Heavy periods can be caused by PCOS, but they can also be caused by conditions like fibroids, endometriosis or adenomyosis.

You deserve more than assumptions. You deserve proper assessment and clear answers.

When the root cause is identified, the right support becomes far more effective — and symptoms can improve dramatically.

If you’re experiencing heavy periods and you’re not sure whether it’s PCOS or something else, I can help.

Book a FREE Naturopathic PCOS Assessment Call and we’ll map out what may be driving your symptoms, what testing or investigations to prioritise, and the most supportive next steps to reduce inflammation, restore hormone balance and help you feel like yourself again.