Heavy periods can be upsetting and disruptive to your normal day to day activities. However, they are common and are often easily treatable. The medical term for excessive or prolonged bleeding is menorrhagia.
You may be suffering from menorrhagia if one or more of the following apply to you:
- You have to change your sanitary towel or tampon every one to two hours
- You need to use both tampons and towels at the same time
- You have to change sanitary protection during the night (known as ‘flooding’)
- You pass large clots of blood
- Your periods interfere with your normal lifestyle, stopping you going out or to work
- You have symptoms of anaemia – fatigue, dizziness, pale skin, shortness of breath
In many cases menorrhagia is not caused by an underlying medical condition. Often its cause is unknown, but there are a number of known causes including:
- Hormonal imbalance – common in young girls experiencing their first periods and women approaching the menopause
- Fibroids (see our fact sheet on fibroids for more information)
- Uterine polyps (see our fact sheet on uterine polyps for more information)
- Endometriosis (see our fact sheet on endometriosis for more information)
- Pelvic inflammatory disease
- Infection of the vagina, cervix or uterus
- Abnormality in the lining of the womb including, in rare cases, cancer
- Use of a IUCD (intra-uterine contraceptive device)
- Sterilisation by tying the fallopian tubes
- Blood clotting disorders – very rare
- Under-active thyroid – also rare
How is menorrhagia diagnosed?
After discussing your symptoms with you, your consultant gynaecologist may need to carry out a pelvic examination. This may involve pressing on your lower abdomen. They may also feel inside the vagina while pressing on your abdomen to check if there is any abnormality in the pelvic area. Your consultant may also use a speculum (an instrument inserted into the vagina to allow the consultant to see the neck of the womb or cervix).
Other tests that may be needed include:
- Blood tests – a sample of your blood may be tested to measure hormone levels, check for anaemia, an under-active thyroid or any abnormalities in the way your blood clots.
- Pelvic or transvaginal ultrasound scan – this is where a probe is passed over the lower abdomen, or inserted into the vagina, and sound waves are used to produce pictures of the womb, ovaries and surrounding pelvic area.
- Hysteroscopy – this is where a small tube which can be used to carry a telescope, camera or surgical instruments is passed through the vagina and cervix and then into the womb. This allows the consultant to view the inside of the womb. A sample or biopsy may be taken at the same time. An anaesthetic is usually, but not always, required for this procedure.
The type of treatment options suitable for you will depend on your age and medical history, whether you are trying to have children and if there is an underlying medical condition. If you have an underlying condition (such as fibroids) this will usually be treated first – see our fact sheets on the individual conditions that cause menorrhagia for treatment options.The following treatment options for menorrhagia are:
- Hormones – such as the combined contraceptive pill or progesterones can help to reduce bleeding.
- Hormone replacement therapy (HRT)
- Anti-inflammatory drugs – to reduce cramping and therefore blood flow.
- The Mirena (contraceptive coil) – reduces the thickening of the lining of the womb to reduce bleeding or, in some cases, stop periods altogether.
- Endometrial ablation – this procedure removes the lining of the womb to reduce its thickness to about five or six millimetres.
This can be carried out under general anaesthetic, or as an outpatient procedure under local anaesthetic depending on the technique used. The procedure can stop periods altogether, though in some cases heavy bleeding can reoccur. It also reduces the possibility of becoming pregnant.
Where none of the above treatments are appropriate or successful, then a hysterectomy may be considered. This is a major operation carried out under general anaesthetic to remove the womb. In some case the neck of the womb (cervix) may also be removed but this will depend on your individual circumstances and your consultant will discuss this with you.
If you have a hysterectomy, your periods will stop and you will be unable to become pregnant.
Watch Miss Zoe Woodward, Consultant Gynaecologist at BMI The Chaucer Hospital, discusses the various treatments available for women suffering with heavy periods.
Your consultant gynaecologist will discuss all the options to find the best treatment for you.