Heavy periods: causes and treatment options

Heavy periods affect 1 in 5 women and this common problem has a significant impact on a woman’s life. We spoke to one of our top gynaecologists Mr Andrew Baxter for his expert medical opinion as to why some women live with the condition, what causes them and all of the possible treatment options for heavy periods, depending on the individual case.

When are periods considered as being heavy?

Periods are considered to be heavy if they are having an impact on a woman’s everyday activities, work and social life. Certain features in the history that suggest that periods are too heavy are:
 

• having to wear pads and tampons together
• flooding through protection
• having to get up at night to change pads
• losing blood clots
• becoming anaemic as a result

What are the causes of heavy periods?

Heavy periods can be caused by physical abnormalities of in the womb such as fibroids or polyps in the lining of the womb. Fibroids are balls in the uterine muscle, while polyps are overgrowths of the lining of the womb.

Sometimes heavy periods can also be associated with conditions where cells from the lining of the womb occur in the wall of the uterus (adenomyosis) or outside the womb in the pelvis (endometriosis). Rarely, heavy periods are an indication that there is a problem with the clotting process in general.

In most cases, however, no cause is found for a woman’s heavy menstrual loss. Heavy periods require some investigations such as an ultrasound scan, a blood test to check for anaemia and sometimes a biopsy from the lining of the womb.
 

What are the treatment options for heavy periods?

When treating heavy periods the aim is to at least reduce the loss to a normal level. Some women prefer to have no periods at all whereas the treatment options for heavy periods consist of:
 

No treatment at all

• Although your periods are heavy, they may not be affecting your quality of life.
   

Medical treatment with tablets

Your GP may have given you one or more of these treatments already and they are certainly worth trying while any investigations are being arranged. If the tablets work you may need no further treatments and you could stay on them for the long-term. The options are:
 

• Tranexamic acid
  This tablet improves the clotting of the blood and reduces the heaviness of periods in over half of cases. These tablets are just taken on heavy days. The tablets are safe although they are generally not advised if you have previously suffered from thrombosis in the past. This medication is not a hormone and therefore does not cause any hormonal side-effects, but some women do experience slight nausea or headaches on treatment.
   
• Combined oral contraceptive pill
  The ‘pill’ is clearly a good contraceptive but is also a proven effective treatment for heavy periods with menstrual loss generally being reduced by 50%. The new advice is to take the pill without a break for as long as you have no bleeding, so this might mean that you have far fewer periods each year. This option is also a good treatment for period pain. You can’t take the pill if you suffer from focal migraine (migraines with visual disturbance), are over 35 years of age or have had a thrombosis in the past.
   
• Progestogen tablets
  These hormone tablets are generally taken from Day 5 to 25 of your cycle but can be taken continuously for a few months. Women can suffer from hormonal side-effects of breast tenderness, headaches, weight gain and mood changes on this medication.
   

Mirena intra-uterine system

• This a hormone-loaded coil that as well as being a very good contraceptive, reduces heavy periods by 90%. In around 20% of cases, periods stop altogether.
• It is generally inserted in the out-patient clinic.
• Women can experience hormonal side-effects with this device such as irregular periods, breast tenderness, headaches and weight gain. These problems settle in the majority of cases, but the advice is to give the device 3 to 6 months to settle.
• The Mirena is also very good at treating some causes of painful periods such as endometriosis or adenomyosis.
• It is good practice to check that the threads of the coil are still present at the neck of the womb after each period, especially if you are relying on the device for contraception.
• The device provides contraception for five years, but occasionally it might need changing earlier than that when treating periods.
   

Endometrial ablation and resection

• The aim of this procedure is to destroy or remove the endometrium, which is the lining of the womb that bleeds with a period.
• The more common outcome of this operation is that women will experience lighter periods, but some may never have any periods again. In around two-thirds of cases, period pain is also reduced.
• Endometrial ablation is generally performed under general anaesthetic as a day case procedure but it can be done under local anaesthetic in the outpatient clinic.
• One of the most tried and tested procedures worldwide is Novasure, which is my preferred technique for women who do not have significant fibroids or polyps. Satisfaction rates with this procedure are over 90% with nearly half of patients never having any periods ever again. This procedure is generally performed under general anaesthetic but it can be done under local anaesthetic in the outpatient department. Further details can be obtained here. 
• If women have polyps or fibroids inside the cavity of the womb these can be cut away with diathermy along with the rest of the cavity lining.
• Women will experience crampy period-like pain for a day or so after an ablation. It is also common to have a vaginal discharge for up to two weeks.
• Ablation avoids major surgery, but it does carry risks of infection, bleeding, perforation of the uterus and rarely damage to the internal organs.
• Endometrial ablation of the entire cavity is only suitable for women who do not want any more children as the ablated uterine lining would make it hard to conceive as well as dangerous to carry a pregnancy. It is therefore important to use contraception after an ablation.
   

Hysterectomy

• Hysterectomy removes the body of the womb which means that periods will stop. It is only an option for women who have finished their family.
• For women who want a guarantee of no periods at all a hysterectomy is the only option.
• It is preferable to have a vaginal or keyhole approach rather than open surgery, as this means that a larger incision is avoided, which makes recovery less painful and quicker. In some women with large fibroids, it may be necessary to perform an open procedure.
• It is normal to be discharged the day after surgery and women are usually back to normal activities by six weeks at the latest.
• There are various types of hysterectomy depending on whether the cervix, tubes and ovaries are removed with the body of the uterus itself. It is important for a woman to discuss all the options with their consultant to make sure they have the best surgery for them.
• Any hysterectomy is associated with the usual risks of surgery, such as bleeding, thrombosis (DVT), and infection. Specific risks of hysterectomy include potential damage to the bowel, bladder or ureters (the tubes from the kidney to the bladder), a collection of blood at the top of the vagina or a change in bowel/bladder habit. A small number of women who retain their ovaries at hysterectomy still can go through early menopause.
• Despite these risks hysterectomy still carries the highest satisfaction rate of all gynaecological procedures.

If you would like to discuss your heavy periods with Mr Baxter and get his expert advice, you can make an appointment with him here via his Top Doctor’s profile. He is also available for a video call using our e-Consultation tool.