Very heavy or very light periods may be linked to underlying health problems that affect quality of life and can influence fertility, according to medical experts.

Heavy menstrual bleeding is reported to have a major impact on daily life, with around two thirds of affected women seeking medical help. Beyond anaemia, which can cause fatigue, dizziness, pallor and a rapid heartbeat, heavy bleeding can lead to social and practical difficulties such as stained clothing, higher use of menstrual products and work limitations.

Doctors stress that the amount of bleeding itself does not directly affect fertility. Instead, abnormal bleeding can reflect underlying conditions, some of which can make it harder to become pregnant.

Raúl Villasevil, a specialist in obstetrics and gynaecology at San Carlos Clinical Hospital in Madrid, Spain, said: “The most frequent causes of heavy periods are polyps, fibroids, adenomyosis, some malignant tumours, ovulatory and coagulation problems, endometrial disorders, and certain medications.”

Very light periods can also signal problems, including uterine malformations, intrauterine adhesions, where scar tissue forms inside the womb, and anatomical abnormalities of the vagina. They may also point to ovulatory and hormonal disorders such as hyperprolactinaemia, which involves excess production of the hormone prolactin, or polycystic ovary syndrome. Once confirmed, these conditions can lead to symptoms including infertility.

To identify the cause of abnormal bleeding, Villasevil said doctors begin with a detailed personal and gynaecological history, followed by a physical examination and usually an ultrasound to assess the uterus and ovaries. Blood tests are also used to check for anaemia, coagulation status and hormonal function.

“This basic evaluation is often sufficient to establish the cause of the bleeding abnormality and to propose solutions. If this basic workup does not identify the cause, additional tests such as hysteroscopy or magnetic resonance imaging can be performed,” he added.

Hysteroscopy involves inserting a small camera into the womb to examine it from the inside.

In most cases, the cause of menstrual abnormalities can be identified and treated. A range of treatments allow a personalised approach for each woman, taking into account whether she wishes to have children, her age and her individual needs at different stages of life.

A non-hormonal radiofrequency treatment improved sexual function and vaginal health in postmenopausal women, according to results from a small randomised study.

The study assessed nonablative capacitive-resistive monopolar radiofrequency, an energy-based treatment that delivers controlled heat to vaginal tissue to improve blood flow and tissue health. It was tested as a potential treatment for genitourinary syndrome of menopause, a condition linked to reduced oestrogen that can cause dryness, irritation and pain during sex.

In the trial, 62 women with genitourinary syndrome of menopause were randomly assigned to receive either six weekly sessions of the active treatment, involving 32 women, or a sham procedure involving 30 women.

Women who received the radiofrequency treatment recorded larger improvements in sexual function, measured using the Female Sexual Function Index, than those in the sham group, both immediately after treatment and at a 12-week follow-up. Average scores increased by 5.86 points after treatment compared with 1.33 in the control group, and by 4.41 points at follow-up, while scores in the sham group declined slightly.

Vaginal health scores showed a similar pattern, with improvements of 4.75 points after treatment and 6.90 points at follow-up, compared with little or no change among women who received the sham procedure.

The research was carried out by scientists at the University of Castilla-La Mancha in Toledo, Spain. They reported no adverse events during the study and found no significant changes in participants’ oestrogen levels.

Stephanie Faubion, medical director for The Menopause Society, said: “This small study provides preliminary evidence on the effectiveness of nonablative radiofrequency on vaginal health and sexual function in postmenopausal women. Additional studies in larger and more diverse cohorts with multidimensional outcome assessments and longer-term follow-up are needed to confirm clinical applicability.”

Nearly 70 per cent of NHS regions in England fund only one IVF cycle for women under 40, breaking national guidelines, new research has found.

Twenty-nine of the 42 integrated care boards, which control local NHS budgets, now offer only one round of treatment, after four reduced access in the past year.

National Institute for Health and Care Excellence (Nice) guidelines recommend three full cycles for women under 40 who have been unable to conceive for two years.

Only two of England’s 42 integrated care boards have policies consistent with these guidelines, which they are not legally obliged to follow.

The research was conducted by the Progress Educational Trust, a fertility charity.

Sarah Norcross, the director of PET, said the impact was “devastating” for couples struggling with infertility.

She said: “Infertility is already incredibly stressful for people, and it puts them under even more pressure, because there is so much riding on whether that one NHS-funded cycle is going to work.

“And for some people, that will be their only chance, because private fertility treatment is so expensive.”

The data showed regional variations, with the whole of the north-west offering just one cycle.

“It’s a postcode lottery, and we’re seeing a race to the bottom,” said Norcross.

Of the 29 integrated care boards that offer a single cycle, 19 provide only a partial cycle, where not all viable embryos created are transferred.

There was just one recent example of improved services, from NHS South East London, which in July 2024 went from one partial to two full cycles.

The NHS estimates that about one in seven couples may have difficulty achieving a pregnancy. One cycle of IVF can cost from £5,000 at a private clinic.

Fertility rates in England and Wales have fallen since 2010 to 1.41 children per woman in 2024, the lowest on record and below the replacement level of 2.1 at which a population is stable without immigration.

Health minister Karin Smyth said in a written parliamentary answer last month that it was “unacceptable” that access to NHS-funded fertility services varied across the country.

Revised Nice fertility guidelines are due this spring, but Norcross said changing them seemed pointless.

She said: “Fertility treatment has always been a Cinderella service. It’s always been the one they’ve chosen to cut or to ignore.

“Nice has recommended three full NHS-funded cycles, for women under 40, for more than 20 years. This has never been implemented across England, unlike in Scotland.”

Norcross advocated centralised commissioning and replicating Scotland’s approach, which included financial modelling and a phased implementation starting with two cycles to avoid long waits, moving up to three once capacity was achieved.

“It is a tried and tested plan that England could follow,” Norcross added.

A Department of Health and Social Care spokesperson said: “We recognise access to fertility treatment varies across the country and we are working with the NHS to improve consistency.

“Nice provides clear clinical guidelines, and we expect integrated care boards to commission treatment in line with these.

“Updated Nice fertility guidelines are expected this spring and we will continue to support NHS England to make sure the guidance is fully considered in local commissioning decisions.”

An NHS England spokesperson said: “These clinical services are commissioned by integrated care boards for their area based on the needs of the local population and prioritisation of resources available.

“All ICBs have a responsibility to ensure services are provided fairly and are accessible by different population groups.”