All women experience their menstrual cycle differently. The amount of blood loss during menstrual bleeding will differ between women and can fluctuate over the years and at different stages of your life. Let’s take a look at heavy periods – also known as menorrhagia.
Heavy menstrual bleeding is very common in women during their childbearing years. Let’s take a look what causes heavy periods and what treatments are avaliable.
What Are Heavy Periods?
Heavy periods are one of the most common concerns for women in Australia. Also known as heavy menstrual bleeding (HMB) or menorrhagia, heavy periods are defined as blood loss greater than 80 ml per period, or a period that lasts for more than eight days.
Heavy menstrual bleeding is very common, especially in women aged 30-50, affecting roughly 1 in 5 in Australia. It can greatly impact daily life and is very distressing for some women. However help is always available.
How Do You Know If Your Period Is Heavy?
It can be quite difficult to determine how heavy your menstrual bleeding is and whether it’s bad enough to see your gynaecologist. Intuition is often your best guide – if you think your bleeding is too heavy and is impacting your day-to-day life or causing you stress or anxiety then it is a good idea to seek help.
There are few key symptoms to keep track of:
• If your period is so heavy that it floods your pad or tampon and cannot be contained
• If you need to change your tampon every hour or less
• If bleeding lasts more than eight days
• If you are passing clots of blood larger than a 50c coin
• If you have to get up at night to change your tampon
• If you bleed through clothes or onto bed sheets
What Causes Heavy Periods?
Many women who experience heavy menstrual bleeding have no abnormalities in the uterus and do not suffer from any exacerbating conditions. Around 50 percent have no underlying cause. The remaining 50 percent could be caused by:
Polycystic ovary syndrome: Women with polycystic ovary syndrome experience an abnormal production of hormones, which can cause ovulation to become inconsistent. These infrequent periods can be very heavy.
Fibroids: Fibroids – also known as myomas or leiomyomas – are benign tumors that can appear on the uterus during a woman’s childbearing years. However, they can cause heavy bleeding and painful periods.
Endometriosis: Endometriosis is condition where the innermost layer of the uterus – the endometrium – grows outside of it, causing painful adhesions on the uterus, ovaries, fallopian tubes and bowel. It can cause painful periods and heavy bleeding.
Endometrial cancer: Cancer of the uterus can cause heavy bleeding. It is more common in post menopausal women, and in women with diabetes.
Endometrial polyps: These are growths in the endometrium that can cause heavy bleeding. Although they are usually benign, it is a good idea to get them removed as they can develop abnormalities and become dangerous.
Endometrial hyperplasia: This is when women develop an abnormally thick lining of the inside surface of their uterus. It can cause heavy bleeding.
Adenomyosis: This is where the when the endometrial glands grow in small pockets in the muscle of the uterus. They can cause painful periods and heavy bleeding.
Chronic disease: Such as kidney disease or liver disease
Hormonal changes and disorders: An overactive thyroid can cause irregular periods. Heavy bleeding is also more common in older women, so is thought to be linked to hormonal changes that occur in the later stages of a woman’s childbearing years.
What Treatments Are Available?
Treatment for heavy menstrual bleeding will depend on the underlying issue. Investigation and diagnosis will usually entail questions about your health, blood tests, examination of your cervix and vagina, a pap test, an ultrasound, or a hysteroscopy.
This is a minor surgical procedure in which your doctor uses a special telescope to look at the inside of your uterus. Your age and medical history will also determine the best treatment solution.
Medication: There are certain medications that can be taken to help reduce menstrual bleeding and assist with pain and bad cramping. Contraceptive methods such as the pill are a common treatment. An intrauterine device (IUD) may also be used to thin the endometrium and reduce bleeding. Progestins, anti-inflammatory drugs and tranexamic acid are also common ways to reduce bleeding.
Surgery: If a surgical option is needed, it will depend on the reason for your heavy bleeding. Procedures to remove polyps or fibroids intruding into your uterus might be required. If no serious pathology is present, a cauterisation of your uterus, called an ablation, might be the best option. Hysterectomy is rarely a first choice, but may prove the best solution for your needs.
Interventional Radiology: If you have fibroids which are not suitable for surgery, or if you have adenomyosis, you may be a candidate for a uterine artery embolisation.
If you have any questions regarding heavy or irregular periods, or would like to book an appointment, please don’t hesitate to give us a call. We will strive to offer advice and compassionate care in every way possible.