Heavy periods

How do I know a heavy period?

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Determining if your periods are heavy may be a difficult thing to do, and different women have different ideas about what a heavy period is.

Medically, heavy menstrual bleeding (HMB) sometimes called menorrhagia is defined as excessive blood loss during menstruation which interferes with one’s quality of life, whether physically, socially or emotionally.

Below is a list of things that may give you an idea how heavy your periods are.

• Using more than nine pads or tampons (or both pads and tampons) on your heaviest days.

• Having to wear both a tampon and a pad

• Period lasting more than six days.

• Having to get up at night to change pads

• Passing clots of blood

• Blood overflowing from the tampons and pads

• Having to stay at home during your period because of fear of an ‘accident’ occuring

• Feeling tired during your period.

Some women have constantly heavy periods, while others have them only around their first ever periods or towards menopause.

What causes unusual vaginal bleeding?

In many cases of HMB, no obvious cause can be found, and luckily, the bleeding doesn’t cause any major problems. However, unusual vaginal bleeding could be caused by another medical condition that needs treatment so it is important to talk to your doctor about it.

Here are a number of possible explanations for unusual vaginal bleeding:

  • Pregnancy: Unusual bleeding can occur during pregnancy. This can occur as the fertilised egg is implanted into the womb. When a fertilised egg develops outside the womb (ectopic pregnancy), usually in the fallopian tube, it may rupture and cause bleeding.
  • Polycystic ovary syndrome (PCOS): In this condition, the hormones especially of the ovaries are not in balance and affect the periods.
  • Fibroids: Fibroids are lumps of non-cancerous smooth muscle that grow in the womb. They don’t usually cause any problems, but can sometimes cause heavy periods among other problems.
  • Miscarriage
  • Endometritis: Endometritis is inflammation (swelling) of the lining of the womb. One of its symptoms is vaginal bleeding.
  • Pelvic inflammatory disease (PID): PID is an infection of the reproductive organs causing inflammation. One of the symptoms is unusual vaginal bleeding.
  • Endometrial polyps: These are non-cancerous growths in the lining of the uterus, which can cause unusual bleeding.
  • Other causes: Cervical cancer and liver problems.

There are investigations available to find out which of the above possible causes is responsible. The doctor will offer some advice and reassurance based on their findings.

What treatments work?

Even if no cause is found for the heavy menstrual bleeding, there are treatments that can help reduce it.

Drugs:

• Tranexamic acid

• Non-steroidal anti-inflammatory drugs (NSAIDs)

• Contraceptive pills, and contraceptive coils fitted into their womb. You probably won’t be able to get pregnant if you have one fitted.

• Gonadotropin-releasing hormone (GnRH) analogues which control pregnancy hormones.

Surgery:

This is rarely recommended except when the heavy bleeding is from other surgical causes like fibroids. But if other treatments fail and the problem is so bothersome, surgery becomes an option. Some of the lining of the womb can be removed through the vagina to reduce the amount that has to be shed at menstruation. This operation is called a dilatation and curettage (D&C).

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