Heavy periods are common, with many women describing their periods as heavy, but it can be difficult to know if your periods are normal or something you should get checked and treatment for. In this article I will talk through how to judge if your periods are heavy, what are the commonest causes and what your options are for treatment.
Every woman will have a different perception of what constitutes heavy menstrual bleeding and what one-woman classes as heavy may be normal for another, and vice versa. Most women will only loose up to 80mls of blood, which is around 16 teaspoons. Heavy Menstrual Bleeding, medically called Menorrhagia, is defined as losing more than 80mls of blood or your periods lasting more than 7 days. It can be really hard to know how much blood you are losing or to measure, but as a general guide, heavy bleeding is likely if you are changing your sanitary pads or tampons every couple of hours or more frequently, you need double protection, your period soaks through clothes or onto bedlinen or if you pass blood clots greater than a 10p piece. It is important to know, that even if the blood loss isn’t quite as described as above, if it impacts you physically, emotionally or socially then you should still see a doctor.
What causes heavy periods?
There are several conditions in the womb (uterus) and ovaries and general medical problems that can cause heavy bleeding, however in around 50% of women, no underlying problem is found so we call this dysfunction uterine bleeding. Uterine and ovarian problems include fibroids, endometriosis, adenomyosis, pelvic inflammatory disease, cancerous or pre-cancerous cells in the vagina, cervix or womb, polycystic ovary syndrome (PCOS), or polyps. Medical conditions include having a blood clotting disorder, an underactive thyroid or diabetes.
How can heavy periods be treated?
There is a range of different treatment options for heavy periods depending on the underlying cause, your overall general health and wellbeing and your preference. Your GP will want to talk through the symptoms you are experiencing and depending on your history may recommend an internal examination, usually with a speculum like a smear test to check they can’t see the cause. They may recommend a blood test to measure your iron level and/or an ultrasound scan to look at your uterus and ovaries. Heavy periods are one of the most common causes of referral to gynaecologist, so depending on the results of any of these tests or your clinical history they may refer you to secondary care to discuss further treatment options.
The recommended first-line management for heavy periods is having an Intrauterine System (IUS)- this is a small plastic device that contains the hormone progesterone. This is similar to a coil and a very small about of progesterone is released daily to thin the lining of the womb to reduce bleeding. In most women, this causes the bleeding to become either very light or stop altogether within 3-6 months. These devices also work as a contraceptive and last between 3-5 years depending on the type. They can be inserted by your GP, or other healthcare professional and can reduce period pain to.
There are hormonal and non-hormonal medications your GP or Gynaecologist can prescribe:
- Non-hormonal options include Tranexamic Acid tablets which work by helping your blood to clot and reduce bleeding by almost half. You need to take these tablets 3-4 times a day for 3-5 days during your period. The other non-hormonal options include anti-inflammatory pain killers such as mefenamic acid or naproxen. These medicines may reduce blood loss by about a quarter and also reduce period pain. These tablets are also taken for a few days around your period.
- Hormonal medication options include the combined oral contraceptive pill (COCP), progesterone tablets or the progesterone injection. The COCP can reduce bleeding by around a third and is contraceptive also. Another option is an oral progesterone tablet called Northisterone but this is often not recommended unless other methods have not worked. This medication is taken around the time of your period but is not contraceptive.
If medical treatments either don’t work or if your family is complete and you feel you would prefer a longer-term solution, then you may be offered surgical treatments. There are three main surgical options – endometrial ablation, uterine artery embolization or a hysterectomy and these procedures are undertaken by a gynaecologist or radiologist, usually at your local hospital.
An Endometrial Ablation is procedure to remove and destroy the lining of the womb either using heat, laser or energy waves. This is usually a day case procedure and involves passing a small specially designed device through the cervix to remove the endometrial lining using either local or a general anaesthetic for pain relief. It is not possible to have this treatment if you wish to have children in the future as it will affect your fertility and can make a future pregnancy dangerous. More than a third of women who have this operation will stop having periods altogether, the majority of other women find that their bleeding is much lighter, but it can take between 3-6 months to see whether the operation has been fully successful. Not all women are suitable or will be recommended this operation, for example if you have large fibroids inside the womb cavity or if your womb is an unusual shape the procedure may not work or be possible.
Uterine Artery Embolisation
A Uterine Artery Embolisation is a treatment option if the primary reason for your heavy bleeding is fibroids, particularly if they are large. It is carried out by a radiologist and involves blocking the blood vessels that supply the fibroid, causing them to shrink and therefore reducing bleeding during your period. This procedure is carried out under local anaesthetic and although it is possible to have a pregnancy afterwards, it can affect your fertility, so it is important to discuss the risks and benefits of this in detail with your doctor.
The most definitive option for heavy periods is a hysterectomy. A hysterectomy involves surgery to remove the uterus (womb) and this will stop you having any periods altogether however, as it is a major operation, doctors will not recommend this unless other treatments have failed. Once your womb is removed you will no longer be able to become pregnant. Depending on your individual circumstances, such as your age, you may also be advised to have your cervix (neck of the womb), ovaries, or fallopian tubes removed at the same time. A hysterectomy is major surgery and all types of hysterectomy require a period of recovery which will vary depending on the type of operation you had, whether there were any complications and how fit and well you were prior to the surgery. In general, we say to allow 6-8 weeks to fully recover but this will vary from person to person.
As you can see there are many different treatments options for heavy periods, with some more invasive than others. Everything is always your choice and you may decide that once you have been reassured regarding the underlying cause, that you would prefer no treatment and to manage your periods conservatively. Many of the first-line, recommended treatments are the same as you may have taken previously for contraception, such as the Mirena coil or the combined-oral contraceptive pill and do not have any long-term consequence or affect your ability to have children in the future. If these initial treatments don’t work, then your GP may discuss referring you to a gynaecologist to talk through some of the more definite options. It is important that if you are experiencing heavy periods, irregular periods, or if you are usure about what is/isn’t normal, that you see your GP as soon as possible.
Dr Ellie Rayner is a practicing Obstetrician and Gynaecologist and founder of The Maternity Collective. She is the only Obstetrician to offer private and group, expert-led Antenatal and Hypnobirthing Classes both Online and face-to-face. She is passionate about providing parent-centred, evidence-based care for all pregnancies and supports all methods of birth.
Follow Dr Ellie Rayner @maternitymedic for the latest evidence-based information on pregnancy, birth and women’s health issues.