Heavy Periods: causes and treatment

Excessive menstrual bleeding, known as heavy periods, is a common symptom amongst females in the UK and worldwide. It can have physical, emotional, social, and financial impact on a woman, but it is not necessarily a sign that anything is wrong. In some cases, no treatment is required, and with the right intervention, a woman can regain their quality of life.

How much is a heavy period?

 The perception of heavy menstrual bleeding is subjective. Most women know
what normal bleeding is for them during their period. They can tell when it changes and become lighter, heavier or irregular. Therefore, it is not usually necessary to measure blood loss.

A heavy period is a blood loss of 80ml or more per month. This means that, a period is likely to be considered heavy if:

  • You need to change your sanitary pad or tampon every 1 to 2 hours.

  • You need to use 2 types of sanitary product together (e.g.both a

  • tampons and a sanitary pad at the same time).

  • You pass blood clots.

  • You bleed through to your clothes or bedding.

  • Your period lasts for more than seven days.

  • You feel tired and drained just after your period.

  • You avoid physical activities or take time off work because of your

  • periods 

What causes heavy periods?

The majority of reasons why someone may suffer from heavy menstrual bleeding are due to dysfunctional uterine bleeding. The womb, ovaries and blood tests are at a normal value. Heavy periods are more common when a woman has recently started her periods or if she is approaching menopause.

Other less common causes includes:

 Conditions that affect the uterus, ovaries, or hormones, such as fibroids (benign growth of the womb), endometriosis (growth of endometrial tissue in sites other than uterine cavity), polycystic ovary syndrome (cyst in the ovaries causing hormonal changes), hypothyroidism and pelvic inflammation.

 Some medications such as chemotherapy, anti-clotting medication, and a copper coil (non-hormonal intrauterine device (IUD)).

How to investigate heavy periods?

The initial investigation will be done using blood tests to check for conditions such as anaemia (low iron), thyroid problems, and clotting dysfunction. An ultrasound scan may be requested to look for any structural cause of the symptoms. This can detect fibroids, polyps, ovarian cysts, and other changes in the uterine linin.

 An endometrial biopsy can be done if the ultrasound scan shows that the lining of the womb is thicker than normal. This is done by inserting a thin tube into the vagina to obtain the sample.

 A hysteroscopy can be performed to look inside the womb with a camera. This procedure involves passing a narrow telescope via the vagina. An endometrial biopsy (a small sample) can also be taken during this procedure.

What are the treatment options for heavy periods?

 The treatment will be case specific and will depend on the cause of the bleeding. The aim of any treatment will be to reduce the amount of blood loss. Treatment options that may be considered are oral during the periods, continuously during the month and the hormonal intrauterine device(IUD). For instance, Tranexamic acid and anti-inflammatory tablets can be used during the period to decrease bleeding.

The combined contraceptive pills and the progesterone only contraceptive pills are examples of medication to take regularly during the month. The Mirena Coil is a hormonal device used intrauterine and it is the most effective treatment for heavy bleeding, reducing blood loss up to 70-100% by 12 months.

 A surgical procedure may be advised depending on whether a cause for the bleeding has been found. For example, a surgical removal of a large symptomatic fibroid may resolve the problem. A hysterectomy (removal of the uterus) is generally one of the last options. This is 100% effective in stopping excessive bleeding, however, this is a large surgical procedure, and the risks and benefits must be weighted.

To conclude

Heavy bleeding is one of the most common reasons that a woman consults her doctor for advice in the UK. It usually presents as losing a lot of blood during a woman’s period or a period lasting for longer than 7 days. This can be natural for that particular woman or caused by womb abnormality or a hormone imbalance. The treatment includes medications to decrease bleeding or surgical procedure. 

 Speak to your doctor if you have symptoms of heavy periods.