What to do? Heavy periods

Heavy periods are common. In most cases no cause can be found. In some cases a cause is found such as endometriosis, fibroids, and other conditions (listed below). In most cases treatment is effective by using medication to reduce bleeding, or by surgery.

What is a normal period, a heavy period, and menorrhagia?

About 1 in 3 women describe their periods as heavy. However, it is often difficult to know if your periods are normal or heavy compared with other women. Some women who feel they have heavy periods actually have an average blood loss. Some women who feel they have normal periods actually have a heavy blood loss. Most of the blood loss (about 90%) usually occurs in the first three days with either normal or heavy periods.

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Some medical definitions of blood loss during a period are:

  • Menorrhagia means heavy periods that recur each month. Also, that the blood loss interferes with your quality of life. For example, if it stops you doing normal activities such as going out, working or shopping. Menorrhagia can occur alone or in combination with other symptoms.

What causes recurring heavy periods?

The cause is not known in most cases
This is called dysfunctional uterine bleeding and is the cause of heavy periods in 4 to 6 out of 10 cases. In this condition, the womb (uterus) and ovaries are normal. It is not an hormonal problem. Ovulation is often normal and the periods are usually regular. It is more common if you have recently started your periods or if you are approaching the menopause. At these times you may find your periods are irregular as well as heavy.

A chemical called prostaglandin may play a part. The amount of prostaglandin in the blood may be different in women with heavy periods. The lining of your uterus is more sensitive to the effects of prostaglandin, which results in heavier periods. In some women, the blood vessels that supply blood to the lining of the womb are larger (dilated), which then results in the blood loss being heavier. This dilatation is also thought to be due to prostaglandins in the body.

Other causes

  • Fibroids. These are benign (non-cancerous) growths in the muscle of the uterus. They often cause no problems, but sometimes cause symptoms such as heavy periods.
  • Other conditions of the uterus, such as endometriosis, infections or polyps, may lead to heavy periods. Cancer of the lining of the uterus is a very rare cause. Most cases of endometrial cancer develop in women aged in their 50s or 60s.
  • Hormonal problems. Periods can be irregular and sometimes heavy if you do not ovulate every month. For example, this occurs in some women with Polycystic ovaries. Women with underactive thyroid may also suffer with heavy periods.
  • The intrauterine contraceptive device (IUCD, or coil) sometimes causes heavy periods. However, a special hormone-releasing IUCD called the intrauterine system (IUS) can actually treat heavy periods (see ‘Levonorgestrel intrauterine system (LNG-IUS)’ below).
  • Pelvic infections. There are different infections that can sometimes lead to heavy bleeding developing. For example, can occasionally cause heavy bleeding. These infections can easily be treated with antibiotics.
  • Blood clotting disorders are rare causes of heavy bleeding. Other symptoms are also likely to develop, such as easy bruising or bleeding from other parts of the body.

If you stop taking the contraceptive pill it may appear to cause heavy periods. Some women become used to the light monthly bleeds that occur whilst on the pill. Normal periods return if you stop the pill. These may appear heavier, but are usually normal.

Do I need any tests if I have heavy periods?

I carry out following tests for heavy periods
1. Full blood count
2. Full and thorough pelvic assessment
3. Internal swabs to rule out pelvic infection
4. Pelvic ultrasound scan
5. Endometrial biopsy
6. Any other test which may become necessary as a result of the above tests such Hysteroscopy ( to look inside womb with camera)

Keeping a menstrual diary

It may be worth keeping a diary for a few periods (before and after any treatment). Please keep the record of frequency of periods, heaviness of periods, any associated symptoms.

What are the treatment options for heavy periods?

Treatment aims to reduce the amount of blood loss.

My approach is completely focussed on patient’s quality of life and trying to return to normality as soon as possible. I consider all the options to treat the problems however the order of the treatment options is completely individualised and bespoke with the availability of the most modern options.

Tranexamic acid tablets

Tranexamic acid are tablets, which can reduce the heaviness of bleeding by almost half (40-50%) in most cases. However, the number of days of bleeding during a period is not reduced, and neither is period pain. You need to take a tablet 3-4 times a day, for 3-5 days during each period. Tranexamic acid works by reducing the breakdown of blood clots in the uterus. In effect, it strengthens the blood clots in the lining of the uterus, which leads to less bleeding. If side-effects occur they are usually minor, but may include an upset stomach.

Levonorgestrel intrauterine system (LNG-IUS)

This treatment usually works very well. The LNG-IUS is similar to an intrauterine contraceptive device (IUCD, or coil). It is inserted into the womb (uterus) and slowly releases a small amount of a progestogen hormone called levonorgestrel. The amount of hormone released each day is tiny but sufficient to work inside the uterus. In most women, bleeding becomes either very light or stops altogether within 3-6 months of starting this treatment. Period pain is usually reduced too. The LNG-IUS works mainly by making the lining of the uterus very thin.

Anti-inflammatory painkillers

There are various types and brands. The best ones are mefanamic acid.

The combined oral contraceptive pill (COCP)

This reduces bleeding by at least a third in most women. It often helps with period pain too. It is a popular treatment with women who also want contraception, but who do not want to use the LNG-IUS. If required, you can take this in addition to anti-inflammatory painkillers

Surgical treatment

Having surgery is not a first-line treatment however some time this is the best option. I always base my decision on number of factors such desire for family, age, severity of symptoms and most of all patients’ wishes.

  • Removing or destroying the lining of the uterus is an option. This is called endometrial ablation or resection. An instrument is passed into the uterus via the vagina. The aim is to remove as much of the lining of the uterus as possible. I prefer the NOVASURE approach. This treatment prevents women from having children in the future. However there have been some pregnancies in otherwise fertile women, so it cannot be used as contraception.
  • Myomectomy Occasionally fibroids are the cause of heavy periods so Myomectomy can also be a option to remove the large fibroids. The fibroids in the uterine cavity are well know cause of heavy periods. A special operation carried out with the help of cameras (Transcervical resection of fibroid) can remove these internal fibroids.
  • Hysterectomy is the traditional operation where the uterus is totally removed. However, hysterectomy is done much less commonly these days since endometrial ablation became available in the 1990s. It may be considered if all other treatment options have not worked for you.

Emergency treatment to rapidly stop heavy bleeding

Some women have very heavy bleeding during a period. This can cause a lot of blood loss, and distress. One option as an emergency treatment is to take a course of norethisterone tablets which is a progestogen medicine. Progestogens act like the body’s natural progesterone hormones – they control the build-up of cells lining the womb (uterus).
This is just a general guidance. If you suffer with heavy period, then please contact Mr Raza for a private consultation