The ‘P’ word
MORE than one in five women suffer heavy periods, rising to one in three when approaching the menopause.
Yet a survey by the ‘Wear White Again’ campaign reveals 62% of women don’t realise it’s treatable and almost half haven’t spoken to a GP.
But help is out there...
Menorrhagia is the medical term for heavy menstruation, says Mr Paul Bulmer, consultant gynaecologist at St George’s Hospital, London.
The womb grows a lining every month in readiness for pregnancy. If there is no pregnancy, this lining is shed. “A heavy period is blood loss of more than 80ml (around four tablespoons) but this is difficult to measure,” says Mr Bulmer. “We ask the patient how long bleeding lasts (over seven days is excessive), what sanitary products are used and how often they need to change them.”
Some women have to double up on protection and many complain of clotting and “flooding” with blood soaking through clothing or bedding.
Other symptoms include pain, feeling tired or weak, depressed or moody. “Heavy periods can have a big impact on quality of life,” adds Mr Bulmer. “If heavy flow keeps you from normal activities, or even stops you from working, seek help.”
In the majority of cases the cause is due to a hormone imbalance.
In some, however, there may be an abnormality that affects the womb cavity.
This may be due to polyps or fibroids – noncancerous growths that develop in or around the womb, or an inflammation due to endometriosis. This occurs when small pieces of the womb lining end up outside the womb. Adenomyosis describes womb tissue lining becoming embedded in the womb wall. Other less common causes include polycystic ovary syndrome (PCOS), pelvic inflammatory disease (PID), an infection of the womb, fallopian tubes or ovaries, an underactive thyroid (hypothyroidism), bloodclotting disorders, and, rarely, cancer of the womb. Don’t suffer in silence. “See your GP who will take a medical history, says Mr Bulmer. “There is a questionnaire and diary at Wear White Again that can be filled out to help your doctor’s diagnosis.”
Your GP will also ask about bleeding in between periods and peeing more often, and may feel the tummy for any lumps, explains Mr Bulmer. “These are ‘red-flag’ symptoms that will need investigation, such as a trans-vaginal ultrasound to rule out fibroids or polyps.”
Updated (National Institute for Health and Care Excellence) guidelines recommend women with heavy periods have a hysteroscopy – a telescopic investigation of the womb via the vagina.
Treatment depends on the patient’s fertility plans too, says Mr Bulmer. Tranexamic acid is a firstline drug that works by slowing bleeding and is to be taken three times a day during periods.
“It reduces bleeding by 50% but is only successful in half of cases,” he says. “Try for one or two cycles.” Alternatively, mefenamic acid is a non-steroidal, anti-inflammatory drug that reduces blood loss by around 20% while also alleviating pain. For those who need contraception, the Mirena intrauterine system has an “antigrowth” effect on the womb lining. For the first few months there may be bleeding between periods but this usually settles. Periods get lighter until they usually stop completely within six months. It lasts for five years but is instantly reversible. Other hormonal options include the combined pill, which works by preventing ovaries releasing an egg each month, the progestogen-only pill, a 12-weekly progestogen injection, and a contraceptive implant that lasts three years. These lighten periods but may cause side effects like water retention and mood swings. If these don’t work or the GP suspects a physical problem with the womb, the patient will be referred to a gynaecologist, says Mr Bulmer. Hospital treatments include:
■ Hysteroscopic morcellation: A hysteroscope is inserted into the womb through the cervix and an instrument called a morcellator is used to cut or “shave” away small abnormalities, such as polyps.
■■ Endometrial ablation: This destroys the womb lining with either laser, heat or ultrasound energy. It can be performed as a day case and usually takes just 15 minutes. Most women have no periods afterwards.
■ Uterine artery embolisation: This treats fibroids and involves inserting a small tube into the groin to block the blood vessels supplying blood to the fibroid.
■ Myomectomy: A procedure to remove fibroids.
■■ Hysterectomy: A 100% effective procedure to remove the womb. It can be done vaginally, by keyhole surgery or by a surgical cut, which requires a hospital stay. “Magnesium is excellent for heavy periods,” says Alison Cullen, nutritionist and menopause expert at A. Vogel supplements.
“It acts as a gentle muscle relaxant so it can help take the edge off very strong contractions of the uterus which can give rise to very heavy periods. “Try incorporating of plenty magnesium-rich foods into your diet. These include dark leafy veg, nuts, seeds, beans and wholegrains.”
If heavy flow keeps you from normal activities, or even stops you from working, seek help from a GP