Heavy periods- what causes heavy bleeding?
How do you know if you have abnormally heavy periods?
The amount of bleeding during a period varies from one woman to another. Abnormally heavy periods (also known as “menorrhagia”) occur when bleeding is heavy enough to have a negative impact on your usual activities and quality of life- physically, socially or emotionally. Women with heavy periods may:
- pass large clots
- leak or flood into their clothing
- need to change their pad or tampon every hour (or more often) by day, and may need to use both a tampon AND a pad some days to avoid leaking
- need to get up at night to change their pad or tampon
- have low iron levels, which can lead to anaemia. Iron deficiency anaemia happens when there’s not enough iron in your red blood cells- with heavy periods, iron is lost through bleeding. Symptoms of anaemia can include tiredness and light-headedness.
What causes heavy periods?
Quite often there’s no obvious reason to be found. However, some underlying causes of heavy periods include:
- Adenomyosis- this is when glands in the uterine lining (endometrium) grow into the muscle layer of the uterus, where they shouldn’t normally be. It may show up on an ultrasound.
- Fibroids- these are lumps that form in the muscle layer of the uterus, in women of child-bearing age. They’re common and not cancerous, but they sometimes can grow very large and cause symptoms like heavy bleeding, pain and pressure on the bladder. They can be diagnosed by ultrasound.
- Uterine polyps- these are benign growths of the lining of the womb
- Uterine (endometrial) cancer
- Endometrial Hyperplasia- this is an overgrowth of the lining of the uterus- over time it can lead to a higher risk of endometrial (uterine) cancer. Endometrial Hyperplasia can happen in PCOS (Polycystic Ovarian Syndrome)- women with PCOS may have no periods for months, but may then get a very heavy one.
- Underactive thyroid gland
- Blood-thinning medications
- Genetic conditions which mean your blood doesn’t clot properly
- Hormonal contraception- whilst many types of birth control actually make periods lighter, some people get heavy bleeding as a side effect.
- STIs (sexually transmitted infections) may cause heavy painful periods, as well as unscheduled bleeding between periods or after sex, abnormal discharge, pelvic pain, burning when passing urine and sometimes fevers and chills.
What tests are needed if you have heavy periods?
- Your doctor will usually ask questions about your health and perform a physical examination
- Blood tests- may include a full blood count and iron levels to make sure you’re not anaemic, a thyroid function test (TFT) and sometimes a blood test to check how well your blood clots.
- STI testing- you may be advised to have tests for sexually transmitted infections including swabs, urine samples and blood tests.
- An ultrasound scan of the pelvis- this may detect if there’s a fibroid, thickened lining of the uterus, a polyp or adenomyosis, for example.
- Sometimes an operation called a hysteroscopy may be needed to take a closer look, as ultrasounds won’t always pick up every issue. This involves a gynaecologist passing a camera into the uterus via the vagina.
- Heavy bleeding can happen in pregnancy- so if there’s any chance you might be pregnant, a pregnancy test should be done.
When should you see a doctor about your heavy periods?
- If heavy periods are disrupting your usual activities or having a negative impact on your life
- If you suddenly start to get heavy periods, having had normal, lighter periods in the past
- If there is ANY bleeding between your periods or after sex
- If you notice any unusual vaginal discharge
- If you have pelvic pain or if sex is painful
- If you have fevers, chills or sweats (this may mean you have an infection)
- If you feel unwell, tired, light-headed or are losing weight for no reason
What is the treatment for heavy periods?
The treatment depends on the cause- if an underlying issue is discovered, obviously it should be treated first.
If no cause is found, options include
- Tranexamic Acid (Cyklokapron)- this medication makes bleeding slow down by increasing clotting
- NSAIDs (Non Steroidal Antinflammatory Drugs), particularly Mefenamic Acid (Ponstan)
- The contraceptive pill or mini pill
- An intrauterine device that releases progesterone, such as the Mirena coil or other long-acting contraceptives
Surgical options are less commonly needed, but may be considered if medical options fail or are unsuitable, and include
- Endometrial ablation- the lining of the uterus is destroyed during this procedure, which is performed by a gynaecologist (there are a number of different methods used). It’s not suitable if you wish to have further pregnancies.
- Myomectomy (if there are fibroids)
- Hysterectomy (usually only considered if all other measures fail)
If you have concerns about your periods or heavy bleeding, speak to your GP.
Further Patient Resources:
Menorrhagia (Heavy menstrual bleeding). mayoclinic.org
Heavy Periods. thewomens.org.au
Article Resources:
Heavy menstrual bleeding: assessment and management. nice.org.uk
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