Why are my periods so heavy?

Heavy periods can have a big impact on your day-to-day life. They can occur for a number of reasons – some benign, and others that may require the attention of a doctor. Leading consultant gynaecologist Mr Jullien Brady explains.

What’s classified as a heavy period?

Classification of heavy periods has now changed to how the periods are affecting a woman. Trying to measure actual blood loss is difficult and measures such as how often a woman needs to change sanitary protection are unreliable. If a woman considers her periods to be heavy, then they should be managed as if they are.

A common benchmark that can be useful to try and judge how heavy periods are is the need to use double protection (towels and tampons), bleeding through night-time protection, and the need to feel housebound or take time off work.

The so called ‘white jeans’ test has also become popular. In this, if a woman is fearful of wearing white jeans during her periods then they can be considered heavy.

Why are my periods so heavy?

Most of the time, heavy periods are not for sinister reasons and are given the medical term “dysfunctional uterine bleeding”. The next most common cause is fibroids in the uterus, which themselves are very common, present in 40 per cent of women over 40 years old.

Once a woman has delivered children, her periods often become heavier as a direct result of the womb becoming bigger.

Rarely, and most commonly in women in their 40s and 50s, a sudden change to heavier periods can indicate an underlying, more sinister cause to the bleeding and would need investigation by a gynaecologist.

Are heavy periods with clots normal?

Blood clots can be normal for some women. I normally advise women to be vigilant of significant changes in their period pattern. This can include heavier, more frequent, or increasing period pain. If this is the case I would advocate review.

Would birth control help make my period less heavy?

Lots of different birth control methods can help reduce the blood flow in periods, and thankfully lots of other options are available to women. Some women may actually decide that they do not need treatment.

For women who may be trying for pregnancy a combination of two tablet types call tranexamic acid and mefenamic acid will satisfy 50 per cent of patients.

For those women who are not trying for pregnancy, many types of hormonal birth control will help in varying degrees. Single-hormone methods with progesterone tend to have more irregular bleeding than two-hormone methods using oestrogen and progesterone, which are probably the most commonly used. Here the pill can be safely used in a continuous fashion for six months, with a withdrawal bleed only occurring twice in a year.

A mirena coil (80 per cent satisfaction) or burning away the lining of the womb (‘ablation’, 90 per cent satisfaction) are often used as second line treatment. These avoid the ‘ultimate’ treatment of hysterectomy (removal of the womb) in the vast majority of patients and the small, but significant, risks associated with the procedure.

When should I go to my doctor about it?

If a woman has any concerns over her periods, then I would suggest review. Lots of different treatment options are available that can be tailored to each woman’s specific needs, desires, and expectations.

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