Heavy Menstrual Periods
Menstruation is a normal part of a woman’s monthly cycle during her reproductive years. It is common to experience a degree of discomfort, cramping, and inconvenience during the week of your period and even the week leading up to it. But if your periods are especially heavy, prolonged, or painful, and interfere with your day-to-day activities, it’s important to see a doctor to rule out any underlying causes and get the treatment you need.
What is heavy menstrual bleeding?
The medical definition of heavy periods, also known as menorrhagia, can be defined as losing more than 80mL of blood (approximately 5-6 tablespoons) during each cycle. But in more practical terms, heavy periods can be defined by their impact on your physical, emotional, and social quality of life.
You may be considered to have abnormally heavy periods if you:
- Pass blood clots during your period that are larger than a 50 cent coin
- Have to change your pad or tampon every one to two hours, including overnight
- Are unable to leave the house on the heaviest day of your period
- Find it difficult to manage your daily tasks due to your period
- Have episodes of flooding, where blood spills through to your underwear or clothing
- Have menstrual bleeding lasting more than eight days
Complications of heavy menstrual bleeding
There are several gynaecological conditions that include heavy periods as a symptom. These conditions can come with their own complications, separate to the heavy periods. However, the heavy menstrual bleeding itself can cause iron-deficiency anaemia through excessive blood loss every month. Having low iron can result in you feeling constantly fatigued, dizzy, and short of breath.
What causes heavy periods?
Identifying the underlying cause is important for guiding Dr Sam Daniels’ treatment recommendations but in some cases, no conclusive explanation for your heavy periods can be determined. Abnormally heavy menstrual bleeding causes can be grouped into three main categories.
Hormone problems
An imbalance in the key hormones that regulate your menstrual cycle can interfere with your periods in a number of ways, including causing them to be highly irregular and infrequent or very heavy and prolonged.
Heavy menstrual bleeding can be a sign of hormonal conditions including:
- Hypothyroidism (an underactive thyroid)
- Polycystic ovarian syndrome (PCOS)
- Peri-menopause (the stage of a woman’s life leading up to menopause)
Uterine disorders
Menstrual bleeding originates from the uterus, as the uterine lining (the endometrium), breaks down and is shed from the body during your monthly cycle if you haven’t fallen pregnant that month.
Conditions of the uterus that can cause heavy periods include:
- Uterine polyps (small non-cancerous growths in the endometrium)
- Uterine fibroids (non-cancerous growths in the muscle of the uterus wall)
- Adenomyosis (abnormal growth of endometrial tissue into the uterus muscle)
- Endometriosis (abnormal growth of endometrial tissue around other pelvic structures)
- Uterine cancer or precancerous changes
Blood clotting problems
You may be more likely to experience heavy menstrual bleeding if you have a blood clotting disorder such as haemophilia, or if you’re taking blood thinning medication. When no underlying cause of heavy periods can be identified, it may be due to a bleeding disorder of the endometrium. Unfortunately, there are currently no tests that can confirm this diagnosis.
Treatment for heavy periods
Through his years of experience as a gynaecologist, Dr Sam Daniels understands how debilitating heavy menstrual bleeding can be, and has seen the impact this condition has on quality of life.
A thorough examination at your first consultation may involve a discussion about your symptoms and how your periods affect your day-to-day activities. Dr Sam may also organise investigations such as a pelvic ultrasound to look for uterine polyps or fibroids, a full blood count, iron studies to check for anaemia, or a biopsy of your uterus to check for cancerous changes.
Non-surgical treatment for heavy periods
Most women will benefit from medical management of heavy menstrual bleeding before considering surgery. Choosing which treatment is most appropriate for you can depend on a few factors, including your personal preferences, whether you have other health conditions to consider, and the underlying cause of your heavy periods.
Hormone treatments
Treatments that combine oestrogen and progesterone hormones, or that use progesterone only, can be very effective at reducing bleeding during your menstrual cycle. These hormone therapies can be taken as a pill, injection, skin patch, or as an implanted intrauterine device (IUD). In addition to relieving the symptoms of heavy periods, these hormone treatments also provide birth control.
Non-hormonal medications
The most effective non-hormonal medication for heavy menstrual bleeding is tranexamic acid, which supports blood clotting. This decreases the amount of blood loss with each period, and can also help with your cramping and pain.
A common off-the-shelf antiinflammatory medication known as ibuprofen can also help to reduce blood loss while relieving the pain associated with your periods.
Uterine artery embolisation for heavy menstrual periods
Uterine artery embolisation is a minimally-invasive procedure performed by an interventional radiologist for women with uterine fibroids. Blocking blood flow to the fibroids causes them to shrink and bleed less. Dr Sam can provide a referral to an appropriate interventional radiologist if you decide to consider this treatment.
Surgery for heavy menstrual bleeding
Surgical treatment for heavy periods often focuses on managing the underlying cause of the excessive blood flow. This can include laparoscopic surgery for adenomyosis, a myomectomy to remove uterine fibroids , or hysteroscopic surgery to treat uterine polyps. In addition to these specific procedures, more significant surgical treatment options for excessive menstrual bleeding include endometrial ablation and hysterectomy.
Endometrial ablation
Endometrial ablation is a surgical procedure to remove or destroy the lining of your uterus (the endometrium) to treat heavy menstrual bleeding. This procedure is only suitable for patients who do not intend to try for a pregnancy in the future. Around half of the women undergoing endometrial ablation will not have any more menstrual bleeding at all, while slightly under half will only have very light bleeding during their periods.
Hysterectomy
A hysterectomy for heavy periods is usually considered as the last treatment option where other less invasive attempts at treatment have not been successful. A full hysterectomy involves removing your uterus, cervix, and sometimes also your fallopian tubes and ovaries, if you are close to or past menopause. Hysterectomy surgery is the only definitive way to guarantee a complete cure of heavy menstrual bleeding, along with any contributing uterine disorders and their symptoms. It is a major operation and should only be considered for women who do not wish to have any children in the future.
Frequently Asked Questions
Endometrial ablation is generally well-tolerated with minimal pain, but it can be common to experience some period-like cramps after the procedure.
Your post-op recovery period is often dependent on what type of surgery you had. Dr Sam practises minimally-invasive laparoscopic and robotic surgical techniques, which offer faster recovery times, a shorter hospital stay, and minimal scarring compared to open surgery. The majority of his patients undergoing surgery for heavy periods will be discharged on the same day of or the day after the operation.
Yes, an intrauterine device can be inserted after endometrial ablation. Dr Sam may also perform an IUD insertion at the same time as the ablation procedure but this comes with specific risks, which he will discuss with you prior to the surgery.
Specialist care for women’s health concerns
Comprehensive care with Dr Sam Daniels is available across multiple Sydney locations, including urgent gynaecologist appointments for time-sensitive cases.