Heavy periods: (menorrhagia)
Menorrhagia means heavy menstrual bleeding. Your periods may be too heavy in two ways: either the same length of time as they have always been but heavy with some women passing large clots or experiencing flooding. Your periods may also be prolonged – lasting longer than 7 days. Often there is an associated shortening of the time between each period.
How do I know if my periods are too heavy?
This is usually difficult to determine. 1 in 5 women will experience heavy periods at some time in their life. Strictly the definition is blood loss greater than 80mls per cycle or periods lasting more than 7 days.
Typically you may be experiencing the following:
- Need to change pads or tampons every hour
- Need to change pads overnight
- Passing large clots
- Bleeding for more than 7 days
- Fatigue, exhaustion, dizziness
Your local doctor may have found that you are deficient in iron or that you are anaemic. The heaviness of your periods may be affecting your daily activities: for example you may start to avoid certain activities at the time of your periods or you may require time off work.
What is the cause of heavy periods?
The most common reason is DUB (dysfunctional uterine bleeding). This essentially means all other known causes have been ruled out through testing. It is due to hormonal or prostaglandin imbalance in the endometrium (internal lining of the uterus).
- Pregnancy or complications of pregnancy
- Endometrial polyps: endometrial growths in the shape of a tear drop. Usually benign but occasionally can involve precancerous cells.
- Endometrial hyperplasia: thickening of the uterine lining that can progress to cancer.
- Endometrial cancer:
- Fibroids: non cancerous lumps within the wall of the uterus.
- Adenomyosis: endometrial cells growing within the wall of the uterus
Bleeding after menopause should always be investigated.
What treatment options are there?
Treatment options are individulised and take into account a woman’s desire to keep her options open for future pregnancies. Medical management includes, iron supplementation, tranexamic acid and hormonal options such as the oral contraceptive pill. A mirena intrauterine device is a very effective way of controlling dysfunctional uterine bleeding with 90% of women being satisfied with this choice at 6 months. Surgical management includes an endometrial ablation (burning of the lining of the womb) or hysterectomy (removal of the womb). Occasionally a myomectomy (removal of a large fibroid) may be considered if a women wants to preserve her uterus. Your treatment options should be discussed with your doctor and the best and safest options decided upon considering your personal circumstances.
What will happen when I visit the specialist?
Often your local doctor will have done some investigations including blood tests and ultrasounds which you should have available for the specialist to see. The specialist will take a thorough history and complete an examination and possibly organize some further testing before a management plan is decided on.