A menstrual period is the shedding of the lining of the uterus (womb) that results in a bleed through the vagina. It usually last for about five days and occurs approximately every 28 days, although any interval between 24 and 35 days is common.
Menorrhagia is the medical term for abnormally heavy periods over several consecutive menstrual cycles. Periods can also be prolonged but this does not necessarily mean that there is anything seriously wrong. Although heavy menstrual bleeding is a common concern, most women don’t experience such severe symptoms that they can’t maintain normal activities during their period. However, if a woman feels that she is using an unusually high number of tampons or pads, experiences flooding through to the clothes or needs to use tampons and towels together, it is a good indication that her blood loss is excessive. Such symptoms can affect a woman physically, emotionally and socially, and can cause disruption to her everyday life.
Some women may also bleed between their periods (intermenstrual bleeding) or after sexual intercourse (postcoital bleeding). All of these issues may require further investigation.
- Vaginal bleeding that soaks through at least one sanitary pad or tampon every hour, over several consecutive hours
- Needing to use double sanitary protection
- Needing to wake up during the night to change sanitary protection
- Bleeding longer than a week
- Passing large blood clots
- Restriction on daily activities due to a heavy menstrual flow
- Anaemia – feeling extremely tired
In most cases there is no particular underlying cause of heavy periods. However, in some cases, causes may include:
- Cervical or endometrial polyps: these are benign growths in the lining of the cervix or womb cavity
- Uterine fibroids: these are benign tumours and sometimes affect older reproductive women
- Pelvic inflammatory disease (PID): this is an infection in the pelvis which can cause pelvic pain and bleeding after sexual intercourse or between periods
- Hormone imbalance: sometimes the build-up of the endometrium (the lining of the uterus/womb) is not sufficiently regulated by oestrogen and progesterone hormone levels. This may arise from obesity, insulin resistance, thyroid problems or polycystic ovary syndrome (PCOS)
- Adenomyosis: this is when glands from the endometrium become embedded in the uterine muscle
- Medication: some medicines for anti-inflammatory complaints, hormonal issues (e.g. oestrogen and progestin) as well as anticoagulants can cause heavy periods
- Pregnancy complications: a single, heavy, late period may be due to a miscarriage. Another cause of bleeding during pregnancy includes an unusual location of the placenta (i.e. low-lying placenta or placenta previa)
- Inherited bleeding disorders, for example, Von Willebrand disease. This is a condition where an important blood-clotting regulator is deficient or impaired
- Cancer of the womb: this is very rare
Initial assessment may include a clinical examination and a blood test to check for iron deficiency (anaemia) caused by excessive blood loss. Further tests such as a pelvic ultrasound scan or other radiological imaging may be required. Some women may also need a biopsy of the lining of the womb.
Based on the results of initial tests, further testing such as a hysteroscopy may be required. This is an examination that involves inserting a tiny camera through your vagina and cervix into your uterus. It can be done under local or general anaesthetic.
Following a diagnosis, the treatment plan will depend on several factors including the cause and severity of the condition, the patient’s health and medical history, the likelihood of improvement over time and plans for future pregnancies.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): taken during one’s period, these can help to reduce menstrual blood loss. NSAIDs can also reduce painful menstrual cramps (dysmenorrhea).
- Tranexamic Acid (Lysteda): also taken during a period, these can help to reduce menstrual blood loss.
- Oral contraceptives: as well as providing birth control, oral contraceptives can help regulate menstrual cycles and reduce episodes of excessive or prolonged menstrual bleeding.
- Oral progesterone: this can help correct hormone imbalance.
- Hormonal IUD: these intrauterine devices release a type of progesterone called levonorgestrel. This makes the uterine lining thin and decreases menstrual blood flow and cramping.
- Iron supplements: for those who are suffering from anaemia.