Heavy menstrual bleeding: Causes, symptoms, and treatment options

Heavy menstrual bleeding, also known as menorrhagia, is a condition that impacts many women during their reproductive years. It can have a significant impact on daily life, making it essential to understand its causes, treatment options, and how it relates to the menopause. Professor T. Justin Clark, esteemed consultant gynaecologist, provides an expert insight.

What is defined as heavy menstrual bleeding?

Heavy menstrual bleeding occurs when there is an excessive amount of blood loss during menstruation. While every woman’s period is different, heavy menstrual bleeding is generally defined as:

• Menstrual bleeding that lasts more than seven days.
• Menstrual bleeding that requires changing pads, tampons, or other sanitary products every one to two hours.
• Menstrual bleeding that includes passing large blood clots.
• Menstrual bleeding that leads to symptoms such as fatigue, dizziness, or shortness of breath due to blood loss. These symptoms may indicate iron-deficiency anaemia.

If heavy menstrual bleeding becomes consistent over several menstrual cycles or if it severely disrupts your quality of life, seeking medical advice is highly important.

What can cause heavy periods?

There are several potential causes. In many instances, the cause is linked to hormonal imbalances, structural abnormalities in the uterus, or other health conditions.

Hormonal imbalances

The menstrual cycle is regulated by hormones, particularly oestrogen and progesterone. If these hormones are out of balance, then this can result in the thickening of the uterine lining. During menstruation, when this lining sheds, the thickened lining can cause heavier-than-usual bleeding. Hormonal imbalances are particularly common in conditions like polycystic ovary syndrome (PCOS) or hypothyroidism.

Uterine fibroids and polyps

Fibroids are non-cancerous growths that form in the uterus and are a frequent cause of heavy periods. Fibroids increase the surface area of the uterine lining, leading to increased bleeding during menstruation. Additionally, uterine polyps - small, benign growths on the inner lining of the uterus - can also play a role in causing heavy bleeding.

Endometriosis and adenomyosis

Endometriosis is a condition in which tissue similar to the uterine lining (known as the endometrium) grows outside the uterus, causing painful and heavy periods. In contrast, adenomyosis occurs when endometrial tissue grows within the muscular wall of the uterus, leading to intense cramping and heavy bleeding.

Medications and IUDs

Certain medications, such as anticoagulants (blood thinners), can make bleeding heavier during menstruation. Additionally, non-hormonal intrauterine devices (IUDs) used for contraception are known to cause increased menstrual flow in some women.

In rare instances, heavy periods may signal more serious conditions, such as uterine or cervical cancer.

How is heavy menstrual bleeding managed and treated?

The management of heavy menstrual bleeding is determined by the underlying cause and the severity of the symptoms. Various treatment options are available.

Medications

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can relieve both pain and menstrual flow during menstruation. Hormonal treatments, including birth control pills, hormonal IUDs, and progesterone therapy, are also frequently prescribed to help regulate the menstrual cycle and decrease bleeding.

Another option is tranexamic acid, a medication that helps in effective blood clotting and can significantly reduce menstrual flow when taken during menstruation. In cases of anaemia resulting from heavy bleeding, iron supplements may be prescribed to help restore blood levels.

Surgical interventions

If medication fails to provide adequate relief, surgical options may be considered. Procedures such as endometrial ablation, which removes or destroys the lining of the uterus, can reduce or stop menstrual bleeding altogether. Uterine artery embolisation is another procedure used to treat fibroids by cutting off their blood supply, causing them to shrink.

For women experiencing severe heavy menstrual bleeding, a hysterectomy (the surgical removal of the uterus) may be suggested. This procedure is considered a last resort and is typically performed only when other treatments have proven insufficient or when there is a potential risk of cancer.

Is there a link between heavy bleeding and the menopause?

Heavy menstrual bleeding may occur as a woman nears the menopause, in a phase called the perimenopause. During this transitional period, hormone levels fluctuate, which can lead to irregular or heavier periods. Therefore, it’s common for women to experience longer cycles or heavier flows during this period, as their bodies prepare to stop menstruation.

While heavy bleeding can be a natural aspect of the perimenopause, any bleeding that occurs after the menopause (postmenopausal bleeding) should always prompt a consultation with a gynaecologist, as it may indicate a more serious condition such as cancer.

If you would like to book an appointment with Professor T. Justin Clark, head on over to his Top Doctors profile today.