Periods are considered heavy if they interfere with daily life, if they stop you from going to work or from doing your normal activities. Medically, heavy periods can cause anaemia (low-iron levels), making you tired. If the blood loss is more than a certain amount (80ml), then this is called Menorrhagia. Periods can be heavy when they last longer than normal (usually 5-6 days) and/or if the flow is very heavy, with clots or flooding, needing frequent sanitary pad change or double protection (Tampons and pads) or if they come earlier every month (usually less than 24 days). Another feature could be pain as a new symptom.
It can affect all age groups but older women often find that their periods are getting closer together and heavier in nature. 1 in 5 women between the ages of 30- 50 years is affected by abnormal uterine bleeding.
Most women with heavy periods do not have anything seriously wrong with them. However, a significant number of women may have a thickening of the lining of the womb (polyps) or benign growths called fibroids which make their periods worse.
It is important to see your GP if your periods for the last 3 months have been lasting longer than normal, or if you having pain more than usual, clots or flooding. If you are feeling particularly tired, it would be sensible to see your doctor for advice. If there is irregular bleeding, bleeding between your periods or bleeding after sexual intercourse, you should not ignore these signs and should see your doctor as soon as possible. If you are above the age of 40, it is especially important to seek advice sooner rather than later. Precancerous and cancerous changes are more like to cause erratic bleeding rather than just heavy periods. Fortunately, these changes are uncommon, especially in women under the age of 40. You must seek advice from your doctor if you have concerns.
Your doctor will take a detailed history about your general condition and about your periods. Blood tests to check your iron levels may be all that is needed, with advice about a healthy diet and lifestyle. Simple medications to help with the bleeding may be prescribed. Depending on your condition, an ultrasound pelvic scan may be organised. A referral to a specialist may be recommended, where further tests may be carried out. Nowadays, it is possible to see inside the womb to investigate women having heavy periods or irregular bleeding. Using no cuts, a small telescope is inserted into the cavity of the womb through the vaginal route. This is called a hysteroscopy. It has a small video camera attached which allows the enlarged picture from the telescope to be seen on a television screen. The procedure can be performed under a local or general anaesthetic, usually as a day case or outpatient procedure. Treatment, if needed, can usually be carried out at the same time, with excellent results.
Leading a healthy lifestyle and eating a good diet, rich in green leafy vegetables will keep your iron levels up (see the Men and women’s health leaflet). However, with heavy periods, the underlying cause, if any, needs to be found and correct treatment started. The most important thing you can do for yourself is to seek medical advice when you have concerns about your heavy periods, especially if not settling with usual medications or if you have irregular bleeding (intermenstrual bleeding). This needs investigation, especially if you are above the age of 40.
Treatment for heavy periods is very satisfactory and has an excellent outcome. Tablets (Nonsteroidal anti-inflammatory drugs such as Ibuprofen or Transexamic acid) may help some women. Removing polyps or fibroids within the lining of the womb (resection) through the telescope (hysteroscopy), can help resolve heavy periods in a number of women. If no polyps or fibroids are found, you may be recommended to have a progesterone containing coil (Mirena IUS) fitted at the same time. This can cause a dramatic reduction of menstrual blood loss with a few months and provide very effective contraception, with minimal side effects. If these above measures are not suitable for you or in the event they don’t work for you, newer procedures such as Endometrial Ablation now provide excellent results. The lining of the womb is removed through the telescope (Hysteroscopy) by a number of techniques (Endometrial Resection or Novasure). This is a very suitable alternative to hysterectomy, with a high success rate in reducing your periods and few side effects, allowing quick recovery and return to work. Some women however may need a Hysterectomy (removal of womb), which can often done through keyhole surgery. This will be decided after discussion and advice from your specialist.
Nitu Bajekal Feb 2009