Heavy Menstrual Bleeding
As women get older and particular after having children periods tend to get heavier. However, periods lasting longer than 7 days or where bleeding is so heavy that you are passing blood clots or having to get up at night to change is not normal and should be investigated.
What causes heavy periods?
In some cases, the cause of heavy periods can’t be identified. However, there are a number of conditions and some treatments that can cause heavy menstrual bleeding.
Conditions that can cause heavy bleeding include:
- fibroids– non-cancerous growths that develop in or around the womb and can cause heavy or painful periods
- polycystic ovary syndrome – a common condition that affects how the ovaries work; it causes irregular periods and when periods return they can be heavy
- pelvic inflammatory disease – an infection in the uterus, fallopian tubes or ovaries that can cause pelvic or abdominal pain and bleeding after sex or between periods
- adenomyosis – when tissue from the womb lining becomes embedded in the wall of the womb
- endometriosis– when small pieces of the womb lining are found outside the womb, such as in the fallopian tubes, ovaries, bladder or vagina (although this is more likely to cause painful periods)
- an underactive thyroid gland – where the thyroid gland doesn’t produce enough hormones, causing tiredness, weight gain and feelings of depression
- cervical or endometrial polyps – non-cancerous growths in the lining of the uterus or cervix
- blood clotting disorders, such as Von Willebrands Disease
- cancer of the uterus (although this is relatively rare)
Medical treatments that can sometimes cause heavy periods include:
- an IUD (intrauterine contraceptive device, or ‘the coil’) – this can make your periods heavier because the copper on the coil can increase bleeding
- blood thinning medication, for example warfarin (taken to prevent blood clots)
- some medicines used for chemotherapy
Investigations for Heavy Periods
Blood tests to check for anaemia and thyroid problems. If polycystic ovary syndrome is possible then androgen levels can be ordered. If a clotting order is suspected, then this can also be tested for on a blood sample.
A pelvic ultrasound scan – to look for structural problems such as fibroids and also to check that the lining of the uterus is normal.
Treatment of Heavy Periods
Treat the cause if the blood tests or scan show the reason for heavy bleeding.
Often there is no obvious cause in which case various treatments can be tried to reduce blood loss. Possible options include medication to take at the time of bleeding:
- tranexamic acid
- non-steroidal tablets to start two days before bleeding is expected – mefenamic acid
- contraceptive pills to take throughout the cycle
- progestogen tablets to take for three weeks out of four
- a progestogen releasing intrauterine system
Referral to hospital
- for treatment to the lining of the uterus using either heat or cold to reduce bleeding from the lining
- treatment to reduce or remove fibroids
- hysterectomy to remove the uterus when other methods have failed