When it rains, it Pours!

Hello ladies! Apologies for the hiatus, needed to reboot!

So if it’s not already obvious from the title, this week I thought it’ll be good to discuss heavy periods- medical term ‘ Menorrhagia’

This is perhaps the most common gynaecology complaint across the world and I’ve been asked a few questions on the topic so let’s try to address it.

Like I always say, this post is a guide and in no way replaces a face to face consultation with a qualified medical professional



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It's often very difficult to define exactly what a heavy period is because it varies from woman to woman. We are all unique in our different ways and a heavy period for one woman may be normal for another.Most women will lose less than 16 teaspoons of blood (80ml) during their period, with the average being around 6 to 8 teaspoons. Heavy menstrual bleeding is defined as losing 80ml or more in each period or having periods that last longer than 7 days, or both.Before we all start trying to measure our periods with teaspoons, most women generally have a good idea of how much bleeding is normal for them during their period and can tell when this changes.Common indicators for a “heavy” period include:

• having to change your sanitary products every hour or two
• passing blood clots larger than 2.5cm 
• bleeding through to your clothes or bedding regularly 
• needing to use two types of sanitary product together – for example, tampons and pads

Causes

It is estimated that in about half of women with heavy periods, no underlying reason is found. However there are several conditions and some treatments that can cause heavy periods and it is helpful to group causes as below;

Womb and ovaries

• Fibroids-  Perhaps the biggest culprit, fibroids are non cancerous growths that can grow in or around the womb and cause heavy periods- will discuss in a future post

  

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• Endometriosis– where the tissue that lines the womb (endometrium) is found outside the womb, such as in the ovaries and fallopian tubes (although this is more likely to cause painful periods) 
• Adenomyosis – when tissue from the womb lining becomes embedded in the wall of the womb; this can also cause painful periods
• PID-an infection in the upper genital tract (the womb, fallopian tubes or ovaries) that can cause symptoms like pelvic or abdominal pain, bleeding after sex or between periods, vaginal discharge and fever
• Endometrial polyps – non-cancerous growths in the lining of the womb or cervix (neck of the womb) 
• Endometrial cancer-the most common symptom is abnormal bleeding, especially after the menopause. Will discuss in  a subsequent post.
• PCOS-a common condition that affects how the ovaries work; it causes irregular periods and periods can be heavy when they start again

Other conditions that can cause heavy periods include: 

• blood clotting disorders
• Hypothyroidsism-where the thyroid gland does not produce enough hormones, causing tiredness, weight gain and low mood.
• Diabetes

Medical treatments also can sometimes cause heavy periods .These include:

•  An IUD (Copper)– this can make your periods heavier for the first 3 to 6 months after insertion
• Medications e.g anticoagulant medication– taken to prevent blood clots
• Chemotherapy
• some herbal supplements, which can affect your hormones and may affect your periods include ginseng, ginkgo and soy.

 Assessment and Treatment

The first step is seeing a qualified medical professional to try to identify a possible cause and then treating the cause. Your doctor will usually start off by asking about your cycle  and changes you have experienced. It is useful to attend this appointment with a good idea about your cycle length and dates.

Your doctor will usually do a blood test to check for anaemia (low iron) due to bleeding. A physical examination will also be useful to to assess further for an underlying cause and you could be referred for further tests such as a pelvic scan, further blood tests including thyroid function tests and a hysteroscopy (using a camera to look inside the womb).

Treatment options include:

An IUS - We have discussed this topic in a previous post , it is a small device that contains progesterone which is usually used for contraception but can be used to treat heavy periods.

Tranexamic acid and non -steroidal anti-inflammatory drugs-These are non hormonal medications that can help with symptoms


Contraceptive pills-The combined pill and progesterone only pills can help control heavy periods.


Surgery- Surgical procedures are mostly aimed at the management of fibroids and procedures include removing the womb lining, procedures to shrink fibroids and in extreme cases, removal of the womb.


There you have it, a brief overview of heavy periods, now this is by no means an exhaustive post and I appreciate that some readers will have questions, if you do please comment below and don't forget to subscribe, follow our Instagram page and share!