HEAVY PERIODS

Most women experience heavy flow and cramps during their menstrual cycle. Nevertheless, it is quite uncommon to have the medical condition commonly referred to as ‘heavy periods’ or menorrhagia.

What Exactly Are Heavy Periods?

Menorrhagia or ‘heavy periods’ occur when a woman’s menstrual cycle lasts more than 7 days. In other words, a woman is said to be having heavy periods if she experiences excessive menstrual bleeding over several menstrual cycles in a row, which may interfere with her physical and emotional quality of life.

Heavy periods are caused by subtle health issues that can result in other health problems. If you notice that you soak through a tampon or a pad regularly, don’t hesitate to speak to your doctor.

However, since the amount of blood loss as a result of this medical condition often varies from woman to woman, making it rather difficult to give a basic description of heavy periods. We have been able to gather some signs and symptoms of heavy periods. Read on to get a clear and concise view.

Some Signs And Symptoms Of Heavy Periods

You might be having heavy periods if you notice any of the following:

• If you have to wear two pads or more at the same time, to control your flow
• Blood loss that requires you to change your sanitary wear frequently, every one to two hours, especially where you are using large sanitary pads.
• When your period lasts more than 7 days
• Frequent fatigue, during and after your period
• If you have been diagnosed with anaemia in the past.
• If you feel that your periods are interfering in the day to day activities of your life
• When your bleeding is so heavy that your seat or sheet becomes soaked with blood while sitting or lying down
• If you notice constant pain in the lower part of your stomach during your periods or menstrual flow
• If you often get tired, lack energy or are short of breath during and after your menstrual flow
• Skip things you love doing as a result of painful cramps
• Bleeding after menopause

Causes Of Heavy Periods Among Women

About 75% of women from 24 to 40 years of age with heavy periods, often have no underlying reason for this medical condition. However, the conditions listed below can sometimes lead to heavy periods in women:

• Endometriosis:

Endometriums are cells that line the inside of the womb. Endometriosis occurs when these cells are present or found in the outer lining of the uterus, like the ovaries or fallopian tubes. This may lead to heavy periods, accompanied by chronic pelvic pain, menstrual cramps and pain during sex.

• Uterine Fibroids Or Endometrial Polyps

Benign or non-cancerous growth of tumours in the womb may also lead to heavy periods.

• Birth Control

Some birth control devices, like intrauterine device, that is often inserted into the womb can increase blood loss during periods.

• Cancer Of The Womb Lining

Although they only occur in rare cases, where adequate care is not taken, it can lead to heavy periods.

• Pelvic Inflammatory Disease (PID)

Pelvic inflammatory diseases are infections in the pelvic area of a woman. Sometimes, chronic PID can lead to heavy periods.

• Polycystic Ovarian Syndrome

This is a condition of having multiple cysts, which are non-cancerous. These cysts, although small, usually grow in the ovaries, and may lead to heavy and irregular periods, as well as other irregularities like excess weight and facial hair.

• Hormone Problems Or Disorders

Every month, linings built up inside a woman womb, pour out in drops or small quantities during their menstrual flow. In cases where hormone levels are not correctly balanced, the body can thicken the lining, which results in heavy bleeding, especially when you shed the thicker lining.

• Complications From Pregnancy

When the male sperm and female egg meet, the growing ball of this cell implants itself in the outer layer of the uterus, rather than the inside. This is often called an ectopic pregnancy. When this occurs, it may lead to serious health problems like heavy bleeding, which is often mistaken for a heavy period.

• Medications

Some medications, like warfarin that are often used to thin periods, can also lead to heavy periods.

• Other Medical Conditions

Other medical conditions or health issues like coagulation disorders and endometrial hyperplasia can also lead to heavy periods.

How Can I Confirm The Diagnosis?

To find out if a woman has heavy periods is not an easy task, because people often perceive heavy periods in different ways. Generally, menstrual bleeding lasts for 4 to 5 days, and the amount of blood lost during this process is minimal. On the other hand, women who have heavy periods usually bleed for more than 7 days and lose more blood than necessary.

When you bleed for more than 7 days per period, or you notice that your period is heavy, such that you have to change your pad nearly every hour, then you may need to see your doctor.

Your doctor should be able to carry out any of the following assessments, depending on the severity of your condition:

• Medical history

Your doctor or a specialist nurse will ask some questions about your medical history; the nature of your bleeding and some other issues relating to the symptoms you have been experiencing. Generally, this may include the following:

• Questions about your menstrual cycle
  • when was your last period
  • how long does your period last
  • how often does your period come
  • what type of sanitary pad do you use
  • how often do you change your sanitary pads or tampons
  • do you experience pain during your menstrual flow
  • how your monthly flow or period affect your everyday life and activities
  • Whether you experience flooding or not.
  • Questions Relating To Your Medication
  • If you take medications for your period and the type.
  • Are you on medication that is not related to your heavy periods?

• Other Questions
  • If you often experience other kinds of vaginal bleeding such as bleeding during sexual intercourse and bleeding between periods.
  • Do you experience pelvic pain during sexual intercourse when you have your periods?
  • What type of contraceptives do you use both at present and in the past
  • The last time you had a cervical smear test, and what was the result
  • If you experience continuous bleeding after a minor cut
  • About your family medical history
  • The number of pregnancies you’ve had and the amount you desire to have in the future.

• Blood Test

Your doctor can also perform one or more of the following blood tests:

• Thyroid Function Test: This test may be used to check for thyroid hormonal imbalance in the system since hormonal imbalance can also lead to heavy periods.
• Full Blood Count:FBC can be used to detect iron deficiency anaemia in the system, which is usually caused by loss of iron following prolonged heavy periods. For cases where your blood tests show that you have iron-deficiency anaemia, your doctor will prescribe a course of iron medicine for you as a treatment.
• FSH/LH:  FSH are hormones that help in controlling the menstrual cycle. Both high and low levels of FSH are often  used to check for irregularities during menstrual flow
• Clotting Screen: Clotting screen can be used to determine if your blood clotting mechanism is responsible for your heavy periods.

• Pelvic Examination

Your clinician or doctor may decide to perform a pelvic examination, to check for enlarged womb or the presence of fibroids. Some of these pelvic examinations may include the following:

• Vulva Examination:  This involves the inspection of your external sexual organs to check for external bleedings and signs of infections in the pelvic area.
• Bimanual Palpation: This involves an internal examination of your vagina. During this process, the clinician or doctor inserts two fingers into your vagina, while using the other hand to press the abdomen gently. This process helps to know if your womb or ovaries are tender or enlarged and to also check for the presence of fibroids in the uterus.
• Speculum Examination Of The Vagina And Cervix Area:The doctor inserts a device called speculum gently into the vagina. This will help your doctor or clinician to inspect your vagina and the cervix for any form of abnormal changes.
• Hysteroscopy

The procedure involves using a telescope usually referred to as the hysteroscope, to examine the shape and lining of the womb. This helps to check for fibroids, overgrowth and polyps in the lining of the uterus

• Pelvic Scan 

It involves the examination of the womb with the use of ultrasound waves to create images of structures in the pelvis. The investigation is painless and can be done either through a trans-abdominal scan or a transvaginal scan. Most clinicians prefer the transvaginal scan since it produces a clearer image of the womb

• Endometrial Biopsy

When a pelvic scan shows that the endometrium is thicker than expected, an endometrial biopsy can be taken to find out the reason for this thickness. The process will involve the insertion of a straw-like tube via the vagina, into the womb. You may experience some crampy pain and a small amount of spotting during this process.

Treatments For Heavy Periods

Generally, the type of treatment you get often depends on the reason for your bleeding and the severity of the problem. Your doctor will also make use of information like your age, general health condition, medical history, how well you respond to some medications, procedures, your therapies and your needs to decide the suitable treatment for you. For example, while some women want to ensure they can still have children in the future, others may be indifferent about giving birth in the future.

All these will be considered before prescribing medications for you. Ensure you discuss your needs and options with your doctor, to ensure you get the best result. Below are some common treatment types utilised by  clinicians or doctors to treat heavy periods:

Drug Treatments

• Levonorgestrel Intrauterine System:  This is a small plastic-like device inserted into the womb. It helps to release the progesterone hormone in small amounts, and at the same time, reduce menstrual bleeding by up to 90%.  Although a temporary effect and condition, it can lead to irregular bleeding when first inserted. Levonorgestrel intrauterine system can act as a contraceptive as well.
• Oral Progesterone: This is taken two to three times a day from days 5 to 26 of your menstrual cycle while counting the first day of your period as day one. It helps in preventing the endometrium from proliferating. Although oral progesterone is not licensed as a contraceptive, it may have some protective effect, since it prevents conception. This means that this treatment option is not suitable for women looking to conceive. Common short term side effects of oral progesterone may include bloating, headache, breast tenderness, and weight gain.
• Tranexamic Acid Tablets: These pills help in reducing heavy bleeding by almost 50%. They work in such a way that reduces the breakdown of blood clots in the womb. The side effects of this pill are often minor and may include stomach upset.
• Combined Oral Contraceptive Pill: Combined contraceptive pill helps in reducing the period bleeding by almost 30% in some women.
• Long-Acting Progesterone Contraceptives: This includes the contraceptive implant and injection. They are quite helpful in treating heavy periods since most women will have no bleeding after the first few months of usage.
• Gonadorelin Analogues: It places the patient in temporary induced menopause, and at the same time, stopping the menstrual cycle. The method is not suitable for long term use, as there are often menopausal side effects, some of which include the thinning of bones.

Surgical Treatment

Surgical treatment may be considered when medical treatments are not effective in resolving the issue. You can only resssort to this method when there is no desire for pregnancy in the future. The following is a list of surgical treatments that can be used for your treatment.

• Operative Hysteroscopy: This surgical procedure involves the use of a special tool to view the interior recesses of the uterus or womb, and can also be used to remove fibroids and polyps from the uterus, while removing the lining of the uterus to manage heavy flows, and correcting other abnormalities of the uterus.
• Dilation and Curettage: Here, the top layer of the uterus lining is removed to reduce the menstrual bleeding. This procedure might need to be repeated after some time by a specialist doctor until the abnormality is resolved.
• Endometrial Ablation Or Resection: It helps to reduce heavy period by removing all or part of the lining of the uterus. However, while some patients may continue to have lighter menstrual flows than before, others will stop having menstrual periods altogether.
• Hysterotomy: This involves surgical removal of the entire uterus or womb. After this procedure, the woman’s menstrual cycle will stop entirely, and she will no longer be able to give birth.

What Happens If I Am Not Properly Treated?

Neglecting issues like this is not an option at all, especially in situations where your condition is severe. Continuous heavy periods for an extended period may lead to anaemia, tiredness, breathlessness and in some cases, a sudden collapse that may need a blood transfusion.

You can only decide to neglect treatment if you feel there is no serious reason for your heavy bleeding, and your periods do not necessarily interfere with your daily activities.

What You Should Do To Help

Whether or not you decide to have medical or surgical treatment, it is essential to have a balanced diet with low fats and high iron content like red meat, spinach, and cereal. This will help in keeping your blood iron level within its normal limits. Some habits like regular exercise, refraining from alcohol and smoking can also help to keep you healthy.

Heavy periods are quite common among women. Regardless, a lot of women barely realise that they can easily seek a solution to this abnormality. A reasonable fraction of women with heavy periods may refuse to find answers to this abnormality because they are often too embarrassed to talk with a doctor about their problem.

Ensure you open up to your doctor for prompt diagnosis with the right and suitable treatment option for your specific issue.

Contact us

Should you have any questions and concerns about heavy periods you would love us to help you with; please call us.