All about heavy periods

While most women experience some variation in their menstrual flow, heavy periods can significantly impact quality of life and may sometimes signal underlying health issues.

Mr Ketankumar Gajjar, renowned consultant gynaecological oncologist, provides an expert insight into heavy periods, their potential causes as well as the available treatments, including medications and procedures.

What is considered a heavy period?

A heavy period, also referred to as menorrhagia, is defined by excessively heavy or prolonged menstrual bleeding. Any of the following may indicate a heavy period:

• Your menstrual cycle lasts longer than 7 days.
• You need to change your pad or tampon every hour for several consecutive hours.
• You pass large blood clots, typically larger than a quarter.
• Your period significantly disrupts your daily activities.

In addition, heavy periods may also lead to symptoms of anaemia, such as fatigue, dizziness, and shortness of breath, due to the significant blood loss.

What causes heavy periods?

There are numerous reasons why a woman might experience heavy periods. Common causes include:

• Hormonal imbalances: A hormonal imbalance, particularly an excess of oestrogen without sufficient progesterone, can cause the endometrium (the lining of the uterus) to thicken excessively, leading to heavier bleeding when it sheds.
• Uterine fibroids: Fibroids are non-cancerous growths that can vary in size and number and often cause heavy menstrual bleeding, particularly if they are located within the uterine cavity or wall.
• Endometriosis: Endometriosis is a condition characterised by the growth of endometrium outside the uterus. This can lead to heavy periods, severe menstrual pain, and fertility problems.

In rare cases, heavy menstrual bleeding can be an early symptom of endometrial cancer. This is more likely in postmenopausal women or those with risk factors for cancer.

What diagnostic tools are used to investigate heavy periods?

Investigating heavy periods involves a series of diagnostic methods to identify the underlying cause. The primary approaches used include:

Ultrasound scan

A pelvic ultrasound is recommended in any of the following scenarios: if a woman’s uterus is palpable abdominally, if a woman’s history or examination suggests the presence of a pelvic mass, if a woman’s examination is inconclusive or difficult to interpret.

A transvaginal ultrasound is recommended to women who experience significant period pain and to women who have a bulky, tender uterus on examination that suggests adenomyosis.

Hysteroscopy

An outpatient hysteroscopy is offered to women whose history suggests the presence of submucosal fibroids, polyps, or endometrial pathology, particularly if they have symptoms such as persistent intermenstrual bleeding or have risk factors for endometrial pathology.

In some cases, an endometrial biopsy may be performed during hysteroscopy for women at high risk of endometrial pathology. This includes women experiencing persistent intermenstrual or irregular bleeding, women with infrequent heavy bleeding who have obesity or polycystic ovary syndrome, and women taking tamoxifen.

What medications are available for heavy periods?

Medications are often the first-line treatment for heavy periods. These can include:

• Non-steroidal anti-inflammatory drugs (NSAIDs): Ibuprofen can help reduce menstrual blood flow and alleviate menstrual cramps. It works by reducing the production of prostaglandins, chemicals in the body that contribute to inflammation and heavy bleeding.
• Gonadotropin-releasing hormone (GnRH) agonists: These medications temporarily stop menstruation and reduce the size of fibroids by suppressing oestrogen production.
• Tranexamic acid: This medication reduces menstrual blood loss by inhibiting the breakdown of blood clots. It's usually taken during menstruation.

Hormonal treatments

Hormonal treatment can also be effective in managing heavy periods by helping to regulate menstrual cycles and reduce the amount of bleeding.

Common hormonal therapies include combined hormonal contraceptives (which contain both oestrogen and progestin), cyclical oral progestogens, and hormonal intrauterine systems (IUS) such as the Mirena coil.

An IUS is generally recommended for women with no identified pathology, women with fibroids smaller than 3 cm in diameter that aren’t causing distortion to the uterine cavity, and women with suspected or diagnosed adenomyosis. In some cases, an IUS may also be recommended for women with fibroids that are 3 cm or larger.

If a woman chooses not to use an IUS or if the device is deemed unsuitable, hormonal treatment options will then be limited to combined hormonal contraception or cyclical oral progestogens.

What procedures are available for heavy periods?

Surgery may be recommended if medication doesn’t effectively reduce your menstrual bleeding. This can include:

• Myomectomy: Myomectomy is a surgical procedure that removes uterine fibroids while preserving the uterus, making it a suitable option for women who want to maintain their fertility.
• Uterine artery embolisation (UAE): UAE is a surgical procedure that interrupts the blood supply to fibroids, resulting in their shrinkage and decreased bleeding. It serves as a less invasive alternative to hysterectomy.
• Hysterectomy: Hysterectomy, which involves the surgical removal of the uterus, is a permanent solution for heavy menstrual bleeding. It’s usually considered when other treatments have failed, and a woman no longer wishes to preserve her fertility.

Heavy periods shouldn’t be ignored, especially if they interfere with daily life or are accompanied by other symptoms. If you have heavy periods, consult with your gynaecologist to determine the cause and appropriate treatment. With the right care, most women can find relief from the symptoms and improve their quality of life.

If you would like to book an appointment with Mr Ketankumar Gajjar, head on over to his Top Doctors profile today.