Don’t put up with it – period!
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Every month. Cramps. Flooding. Waking at night. Changing underwear, bed sheets, towels. Anaemia. Feeling ghastly. One in five women will know exactly what I’m talking about – heavy periods, known in the medical world as menorrhagia, can be truly awful.
And, for some women, they last more than a week, which means that you could end up feeling like this for a quarter of your reproductive life.
The good news is, in almost all cases, heavy periods are treatable, and compared with the ‘‘olden days’’ when surgery was really the only choice, a hysterectomy is now reserved for when the medical options have failed or aren’t suitable.
Although it sounds simple, actually defining heavy periods can be tricky.
The official definition is that your periods are heavy if you lose more than 80ml of blood each cycle.
However, as most of us don’t – and shouldn’t – try to measure our blood loss each month, this is hard to gauge. The following symptoms are a sign that you probably have heavy periods, and should talk to your doctor: Frequent flooding through tampons or pads; Changing your pads or tampons more than fourhourly, and having to change them overnight, or using ‘‘double protection’’ to avoid this;
Iron deficiency anaemia due to heavy bleeding; Your periods getting a lot heavier than they used to be;
Bleeding for more than seven days each month; Passing blood clots larger than 3cm (small clots
can be quite normal for many women);
Restriction to your lifestyle because of the blood loss.
In most cases, heavy periods are just the way you are – this is called ‘‘dysfunctional uterine bleeding’’, and simply means there isn’t an abnormality of the womb, your bleeding is just heavier than normal. This doesn’t mean it shouldn’t be treated, it just means that there isn’t an identifiable underlying cause. Other issues that can lead to heavy bleeding include:
Fibroids – benign growths of muscle in the womb wall, found in up to one-third of women. Small fibroids shouldn’t cause any problems, but large ones are often associated with heavy blood loss and pain. Endometrial polyps – small growths in the lining of the womb, often associated with bleeding in between periods as well;
Endometrial hyperplasia – this just means a thickening of the womb lining, but needs to be assessed as in some women it can lead to cancer of the womb;
Less common conditions including adenomyosis, thyroid problems, intra-uterine contraceptive devices (IUCDs), blood clotting disorders, and endometrial cancer (cancer of the womb lining).
If you have heavy periods, it is important to book a doctor’s appointment – firstly to discuss treatment to improve your symptoms, secondly to treat any anaemia resulting from the bleeding, and thirdly to rule out one of the more serious conditions mentioned above.
Your doctor will need to do a pelvic examination – this is a similar process to having a smear, and will enable the doctor to check the size of your womb and ovaries.
He or she will also suggest a blood test to check your haemoglobin and iron levels, and exclude conditions such as thyroid disease. Lastly, your doctor may want to order an ultrasound scan – this is a more sensitive way of checking the womb, and can usually pick up a range of abnormalities, including fibroids, cysts and thickening of the womb lining.
If there are any concerns based on these initial tests, you may be referred to a specialist who can perform a procedure called a hysteroscopy – this allows the doctor to look inside the womb, and takes samples from the lining itself.
Most women won’t need this, and can be treated successfully by a GP.
Treatment options depend on what age and stage of life you are – for example, the contraceptive pill is a good choice, but obviously isn’t the right one for you if you are trying to get pregnant. Other options include:
❚ Non-steroidal anti-inflammatories – known as NSAIDs. This group of drugs includes ibuprofen, diclofenac and naproxen. As well as being useful for pain relief, they will reduce blood flow by up to one-third if used correctly. They should be taken just before or at the start of a period, and used regularly for the heavy days.
❚ Tranexamic acid – this non-hormonal medication affects clotting mechanisms, and reduces blood flow by up to half. It can be used in combination with NSAIDs, and is just taken for the first few days of bleeding each cycle.
❚ Oral progesterone – taken for 21 days each month, this medication can reduce flow and regulate cycles. However, it is often associated with
Treatment options depend on what age and stage of life you are – for example, the contraceptive pill is a good choice, but obviously isn’t the right one for you if you are trying to get pregnant.
bloating and mood swings so doesn’t suit everyone.
❚ Danazol – this can be really effective but also has unpleasant side effects so is usually reserved for cases where other treatments aren’t appropriate or haven’t worked.
❚ Mirena or jaydess intrauterine device – fitting a hormone-releasing ‘‘coil’’ or IUCD into the womb is one of the most effective methods we have of treating heavy bleeding. Nearly all women will get around a 90 per cent reduction in their bleeding, but it can take some months to work effectively. It can remain in place for several years, and has the added benefit of being a contraceptive.
If you do need specialist treatment and these measures haven’t worked, treatments include ablation of the womb lining (basically removal of the womb lining using either surgery or heat), myomectomy (excision of any fibroids), or hysterectomy (removal of the womb itself).
For more information, visit healthnavigator.org.nz or talk to your doctor.