What to know about heavy periods: Causes, testing and management

Although one woman’s definition of a heavy period may differ from another, significant blood loss can often disrupt daily life and cause discomfort. In this informative guide, revered consultant obstetrician and gynaecologist Mr Amer Raza shares his detailed insight on common causes of heavy periods as well as the types of testing that can be helpful in assessing menstrual health. In addition, Mr Raza discusses the available options to help women manage recurrent heavy periods.

How are heavy periods defined?

Roughly one in three women characterises their menstrual flow as heavy. Nonetheless, distinguishing between what constitutes a normal or heavy period in comparison to other women can often pose a challenge.

Some women who perceive their periods as heavy might actually experience an average blood loss, while others who consider their periods normal may undergo significant blood loss. Irrespective of whether the menstrual flow is normal or heavy, the majority of blood loss (approximately 90 per cent) typically transpires during the initial three days of a woman’s period.

Menorrhagia refers to heavy menstrual periods that reoccur monthly and significantly disrupt your quality of life, hindering normal activities like work, socialising, or being active. Menorrhagia can develop on its own or alongside other symptoms.

What causes of recurrent heavy periods?

In most instances, the cause of recurrent heavy periods is unknown. This is referred to as dysfunctional uterine bleeding, which is responsible for heavy menstrual periods in between four and six out of every ten cases. Dysfunctional uterine bleeding occurs when the uterus and ovaries are structurally normal and surprisingly, it is not driven by hormonal imbalances. In addition, ovulation and menstrual cycles are usually regular. This condition tends to be more prevalent during the early onset of menstruation or as menopause approaches, often resulting in irregular and heavy periods.

Although the cause of dysfunctional uterine bleeding is not clearly established, prostaglandins (a chemical compound) may play a role in this condition. Variations in prostaglandin levels within the bloodstream may impact the sensitivity of the uterine lining, leading to heavier menstrual flows. Additionally, some women may have larger (dilated) blood vessels supplying the uterine lining, a phenomenon thought to be influenced by prostaglandins.

Other potential causes include:

• Fibroids
• Uterine-related conditions
• Hormonal abnormalities
• Intrauterine contraceptive devices (IUCD or coil)
• Pelvic infections
• Blood clotting disorders

Do I need tests to evaluate my heavy periods?

In my own practice, I perform the following tests for heavy periods:

• Complete blood count
• Thorough pelvic examination
• Internal swabs to rule out pelvic infections
• Pelvic ultrasound scan
• Endometrial biopsy
• Any additional tests that may become necessary based on the results of the above examinations, such as hysteroscopy to visualise the uterine interior with a camera

Maintaining a menstrual diary could be beneficial. Documenting the frequency and heaviness of your periods, along with any accompanying symptoms, can offer valuable insights before and after any treatment.

What options are available for managing heavy menstrual periods?

The primary objective of treatment is to mitigate blood loss, with a focus on enhancing the patient's quality of life and facilitating a swift return to normalcy. Treatment options are personalised and tailored, considering the availability of contemporary approaches. These options may include:

• Tranexamic acid tablets
• Levonorgestrel intrauterine system (LNG-IUS)
• Anti-inflammatory pain relievers
• Combined oral contraceptive pills (COCP)
• Surgical interventions
• Emergency measures to rapidly halt excessive bleeding

If you are experiencing recurrent heavy periods and wish to schedule a consultation with Mr Raza to explore your treatment options, you can do so by visiting his Top Doctors profile.