Heavy Periods

Heavy periods are experienced by many women, but it affects different women to different extents.  “Normal” menstrual bleeding is defined as less than 40ml of blood loss per menstrual cycle.  Heavy periods, or “menorrhagia” in medical terminology, is defined as menstrual blood loss of over 80ml per menstrual cycle.  However, it is not possible or practical to measure the precise volume of menstrual blood loss in women with heavy periods.

Many women will get her period for three to seven days each cycle.  The amount of menstrual bleeding each day varies, and can sometimes vary from month to month.  What one woman considers a “normal” period may be considered “heavy” for someone else.

Heavy periods is a common problem, and studies indicate that up to 35% of women in the general population may have menorrhagia.  However, some women are not bothered by her symptoms, whilst others are too embarrassed to seek help.

There are 2 main reasons for women to seek medical attention due to heavy periods:

1. When the heavy periods are affecting the woman’s ability to do the things she wants to do – interfering with work/school, and/or family life.  This can significantly affect a woman’s quality of life.  Heavy periods may often result in absenteeism from work or school, and can be troublesome for couples wanting to have sexual intercourse.
2. When the heavy periods are causing low iron levels or anaemia.  This can lead to symptoms such as tiredness, headaches, or dizziness/lightheadedness.

Heavy Periods – Causes

Heavy periods may be due to:

• Anovulatory cycles
• Fibroids
• Endometrial polyps
• Adenomyosis (endometriosis within the muscle layer of the uterus)

In most cases, the cause for the heavy periods is benign, but heavy periods in women who are approaching the menopause need to be investigated thoroughly to rule out endometrial hyperplasia or cancer as the underlying cause for the heavy periods.

Heavy periods in young girls are usually due to anovulatory cycles, but occasionally this may be the first presentation of a bleeding disorder in a young girl.

Heavy Periods – Treatment Options

Women with heavy periods often have low iron levels, and iron supplementation is important.  Taking vitamin C at the same time as taking iron tablets will significantly improve the absorption of iron by the body.  If the woman’s iron stores have been depleted due to the chronic heavy periods, it may be necessary to take iron supplements for up to 2-3 months even after the heavy periods have been successfully treated.

Treatment options for heavy periods depends on the underlying cause, but can include:

• Hormonal therapy
  • Oral contraceptive pill
  • Mirena
  • Other progesterone therapy
• Medications that help reduce bleeding
  • Tranexamic acid (Cyklokapron)
  • Mefenamic acid (Ponstan)
• Surgical removal of fibroids
  • Submucosal fibroids may be removed via hysteroscopic resection
  • Subserosal and intraumural fibroids may be removed via laparoscopy
• Surgical removal of polyps via hysteroscopy

For women who have completed their families, the following options are also available:

• Endometrial ablation (e.g. NovaSure procedure)
  • Endometrial ablation is a procedure whereby the lining of the uterus (endometrium) is destroyed.  This is done as day surgery, and the procedure takes less than 15 minutes to perform.  The success rate for endometrial ablation is generally very good, with over 80% of patients reporting satisfactory reduction of their periods.
• Hysterectomy
  • Laparoscopic hysterectomy
  • Vaginal hysterectomy

Dr Ken Law is a gynaecologist who specialises in the diagnosis and treatment of women in Brisbane with heavy periods.  He offers comprehensive care for these women, identifying the cause of the problem, giving a detailed explanation and options for treatment.  To discuss your specific concerns and menstrual disorder with this Brisbane gynaecologist, please contact Dr Ken Law to arrange an appointment at Greenslopes Obstetrics and Gynaecology.