Heavy periods

Introduction

Some women lose an excessive amount of blood during their period. It is difficult to define exactly what a heavy period is, and what is heavy for one woman may be normal for another. The average amount of blood lost during a period is 30-40 ml, with 9 out of 10 women losing less than 80ml. Heavy menstrual bleeding is considered to be 60ml or more in each cycle.

It is not practicable to measure blood loss. Most women have a good idea about how much bleeding is normal for them during their period and can tell when this amount increases or decreases.

A good indication that blood loss is excessive is if:

  • an unusually high number of tampons or pads is necessary
  • heavy bleeding runs through to clothes or bedding
  • passage of clots
  • need to use more than one protection, more than one pad at one time or tampons and pads together

Causes

The medical term for heavy periods is ‘menorrhagia’, and may be associated with pain. Heavy bleeding doesn’t necessarily mean there’s anything seriously wrong, but it can affect a woman physically and emotionally, and disrupt everyday life. The commonest cause is dysfunctional, which affects women in their forties, and is related to hormonal imbalance. The heavy periods may be significant, but is often self-limiting and periods may return to normal after a few months.

Heavy periods may be caused by fibroids which are benign growths in the muscles of the womb and by an endometrial polyp which is a localised overgrowth of the lining of the womb (endometrium).

Adenomyosis is a common condition where the inner lining of the uterus (endometrium) grows into the muscle wall of the uterus, and is associated with menstrual cramps, lower abdominal pressure, bloating before menstrual periods and heavy periods.

Treatment

Dysfunctional menstrual disorders can be treated by non- hormonal and hormonal medications. Drugs like Tranexamic acid and Mefenamic acid taken during the period days help in reducing the blood loss, and may be the treatment of choice. Some women respond better to an estrogen- progestogen preparation or to only progestogens. Heavy periods caused by sub-mucosal fibroids and endometrial polyps improve after surgical treatment. Heavy periods associated with adenomyosis may be difficult to manage with medicines, and may need surgery such as thermal ablation or hysterectomy.