What causes my period to be so heavy?

Author: Dr Peter England, Obstetrician and Gynaecologist

Menorrhagia is the medical term for excessively heavy periods. This annoying, often distressing complaint causes a lot of chronic ill health as well as monthly disruption to many women trying to go about their normal life.  

While there is no exact definition, a good way to think about it is, if the amount of bleeding you have is becoming difficult to manage and causing you to miss school/uni/work, disrupting your family commitments and/or causing you stress trying to manage your bleeding, you may have menorrhagia.  

How to say Menorrhagia = meh·nuh·rei·jee·uh. 

How do I decide if my periods are too heavy compared to normal?  

Things you may notice during a heavy period: 

  • You may experience an unusual increase in menstrual loss 
  • Your periods last longer than 7 days (excluding spotting) 
  • You need to change protection every hour or two and experience episodes of flooding and accidents with clothing and bedsheets 
  • Missing sleep because of frequent overnight changes
  • Passing blood clots of 3cm size or more 
  • You become iron deficient.  

Any of the above probably means your periods are much heavier than they should be. 

A normal period is around 80ml blood loss for your entire period. 

You may find disruption of your daily activities is becoming problematic on a cyclic basis rather than a minor inconvenience. 

What causes periods to become heavy?  

There are many abnormal gynaecological disorders that can lead to menorrhagia. These include fibroids, endometrial polyps, endometrial hyperplasia, adenomyosis and endometriosis, and cyclical hormone imbalance. Establishing the cause leads to the correct options for treatment offered to you.

Why do I become iron deficient or anaemic from menorrhagia? 

Iron is an important constituent in red blood cells (RBCs). RBCs are made in the bone marrow continuously and have a lifespan of 120 days. Think of iron as fuel for your bone marrow. If month after month you lose blood at a greater rate than your bone marrow can replace it then you become iron deficient. If this goes on long enough your red blood cell count will drop and you will be anaemic.  

When your levels drop, you will be chronically tired and have poor exercise tolerance. 

What should I do if my periods are too heavy? 

You should see your GP to be assessed. If your doctor is concerned you can obtain a referral. I will listen to your history and how the problem is affecting you, perform an internal examination and a pelvic ultrasound. If a pap smear or swabs to exclude infection are required that’s easy to do at the same time. Blood tests for your blood counts and iron will usually be requested. Sometimes this is all that’s required, and some treatment can be commenced to help you with the heavy periods. Other times it is apparent that further investigation such as a hysteroscopy and curette (examination of the uterine cavity under anaesthetic) is needed, or on occasion a laparoscopy if infertility or ovarian cysts). 

What are some medical treatments available?  

Your choice of treatment depends on your symptoms, the cause, your age and childbearing status. It is a complex decision that you ultimately decide based on the information I can give you and your own preference. Treatments can be divided into medical and surgical.  

What are the medical treatments available for helping with menorrhagia?

Non-steroidal anti-inflammatory drugs (NSAIDs) reduce menstrual loss on average by a third and when taken regularly for the first 48-72 hours of the period reduce menstrual pain and menstrual headache. They are best taken with food. Some examples are ibuprofen (Nurofen), diclofenac (Voltaren), mefanemic acid (Ponstan), and naproxen (Naprosyn). The more doses you have the greater the effect over the 72 hours. Only take what the recommended dose is, or as directed by your doctor.  

Oral contraceptive pills are a popular and effective method of reducing period blood loss and often pain too. They also come with the added advantage of contraception if you require it. There are many types of oral contraceptive pills available as women are all slightly different and you may tolerate one kind better than another.  

Oral progesterone, taken cyclically is effective but can be accompanied in some women by typical premenstrual type symptoms. Tranexamic acid (aka Cyclokapron) can reduce menstrual loss by up to two thirds if taken regularly as prescribed for the first 48-72 hours of your period. This promotes effective clotting of the blood in the lining of the uterus thus slowing the loss.  

The progesterone-based IUD (aka Mirena) is very effective at reducing menstrual loss and has been a popular addition to treatment options for over 20 years in Australia. It is also a contraceptive. I am usually able to insert this in the rooms, occasionally a Mirena needs to be done under anaesthetic.  

Will I need surgery to manage my heavy periods?  

If there are large fibroids, removal via a myomectomy can be considered. If you have completed your family and conservative options are not working, then either an endometrial ablation (removing the lining of the uterus) or hysterectomy (surgical removal of the uterus) can be discussed as an option for you. 

Make an appointment to discuss your personal health. Contact us here, or give us a call.

Author: Dr Peter England, Obstetrician and Gynaecologist.
Read more about Dr Peter England

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