Heavy periods can lead to anaemia
Idon’t imagine there are many women who actively look forward to their ‘‘time of the month’’. However, for some, this can actually be a truly awful time, with unmanageable bleeding and pain. The medical word for this is ‘‘menorrhagia’’, and it is thought to affect up to one in three women.
If you are one of the thousands of women affected by this each month, don’t despair – there are really good treatment options available now to suit almost everyone, so book an appointment with your doctor and talk it through. It could transform your life.
Menorrhagia is the term given to periods that are long and heavy – but this can be very hard to accurately assess or define.
Some women who complain of heavy bleeding, probably have ‘‘normal’’ levels of blood loss, whereas others may cope with much greater blood loss but consider it normal. So personally, I prefer to think of ‘‘menorrhagia’’ as blood flow that is greater than the individual woman can reasonably manage or cope with. This might include:
Periods that last longer than the average seven days.
Periods that are very heavy (scientifically defined as greater than 80mls of blood loss per cycle).
Large blood clots during your period.
Flooding either onto clothes or bedding.
Frequently needing to change your pad or tampon (for example, every hour), or needing to use ‘‘double protection’’ to avoid flooding.
Periods that are so heavy they lead to iron deficiency and anaemia. If your periods are consistently heavy or long, as well as developing potentially dangerous anaemia, it can have a huge impact on your well-being and ability to work and function as you’d like. I know patients who have regularly had to take days off work each month to cope with their bleeding – a situation that clearly isn’t sustainable or beneficial for anyone.
Interestingly, around half of women who have menorrhagia will have no identifiable cause – this is known as ‘‘dysfunctional uterine bleeding’’ (DUB). DUB is more common at either end of your reproductive life – so at menarche (when your periods start) and menopause (when they finish).
Other conditions that can cause heavy bleeding include: Hormonal imbalances. Fibroids (benign, muscly growths inside the womb).
Polyps (small growths on the wall of the womb or cervix). Endometriosis. Infection. Endometrial hyperplasia (an overgrowth of the womb lining). Thyroid disease. Kidney or liver disease. Bleeding disorders. Copper intrauterine devices (but not intrauterine systems which have the opposite effect).
Malignancy of the genital tract – although not a common cause of menorrhagia, it is really important to consider and exclude this, especially in someone who has previously had normal periods, and suddenly develops heavy, irregular or long ones. To try and work out what might be causing your menorrhagia, your doctor will need to do a blood test, checking for anaemia and thyroid disease, as well as an ‘‘internal’’ examination to assess the size and shape of your womb.
If there are any concerns, they will also request an ultrasound scan which is a sensitive way of detecting lumps and bumps such as polyps and fibroids. Specialist gynaecologists can also perform biopsies (or samples) of the womb lining if needed to get a more detailed look at things.
Your treatment choices will depend on whether or not you have one of the conditions mentioned above – they will all require different management, most of which can be overseen by a GP without the need for ongoing specialist care.
To manage the heavy blood flow itself, especially if you have DUB (ie no identifiable underlying cause), the following are all good options to consider:
Non-steroidal antiinflammatories: simple ‘‘NSAIDS’’ such as ibuprofen, naproxen and diclofenac can reduce blood flow by around 25 per cent, as well as providing good relief from pain and cramping. This is a great option to try first, as you can usually purchase these over-thecounter at your local pharmacy.
Tranexamic acid: also known as ‘‘cyclokapron’’, this medication is taken at the start of each period, up to four times a day. Many women find it really effective at reducing blood flow, and like the fact they only need to take it whilst they are menstruating.
The combined contraceptive pill: if you also need contraception and can safely take the pill, this is a great option. It can be taken continuously, by skipping the ‘‘sugar pills’’, thus avoiding the need to have periods at all.
Intrauterine systems, known as Mirena or Jaydess, are the first choice for many women – they release a tiny amount of a progesterone-like hormone into the womb, reducing or stopping periods completely, and providing great contraception as well.
Surgery: if you have completed your family, it is worth considering a more permanent surgical option, such as endometrial ablation or hysterectomy. For more information visit healthnavigator.org.nz
Dr Cathy Stephenson is a GP and medical examiner.