Summary

  • What is heavy menstrual bleeding?
  • What causes heavy menstrual bleeding?
  • What tests need to be done to find out the cause of heavy menstrual bleeding?
  • How is heavy menstrual bleeding treated?

Q: What is heavy menstrual bleeding?

The key to defining heavy menstrual bleeding is your perception of heavy bleeding. It is difficult to measure menstrual bleeding but your bleeding is heavy if it causes one of the following

  • Flooding through to clothes or bedding
  • You need frequent changes of sanitary towels or tampons
  • Your need double sanitary protection (tampons and towels)
  • You pass large blood clots
  • If it stops you doing normal activities such as going out, working or shopping

Q: What causes heavy menstrual bleeding?

The exact cause is not known in most cases this is dysfunctional uterine bleeding. In this condition the uterus (womb) and ovaries are normal. It is not a hormone problem. Ovulation is usually normal and the periods are regular.

A chemical called prostaglandin may play a part. The amount of prostaglandin in the lining of the uterus is often higher than normal in women with heavy periods. The high level of prostaglandin may affect blood clotting within the uterus. Bleeding then takes longer than normal to stop.

Other causes
These are less common. They include the following:

  • Fibroids and other conditions of the uterus such as endometriosis, infections, polyps. Cancer of the lining of the uterus (endometrial cancer) is an uncommon cause. This occurs in a small number of women, usually over the age of 40.
  • Hormone problems. Periods can be irregular and sometimes heavy if you do not ovulate every month. Also in the years close to the menopause, periods can become heavier and/or irregular. An underactive thyroid gland may possibly cause heavy periods.
  • The IUD (Intrauterine Device or 'coil') in the past sometimes caused heavy periods. However, a special hormone-releasing IUD can actually treat heavy periods (see below).
  • Warfarin or similar medicines interfere with blood clotting. If you take one of these medicines for other conditions, it may have a side-effect of heavier periods.
  • Blood clotting disorders are rare causes of heavy bleeding. Other symptoms are also likely to develop such as easy bruising or bleeding from other parts of the body.

Q: What tests need to be done to find out my cause of heavy menstrual bleeding?

Tests done by your GP
Your GP will take a full history of your periods. It may be helpful to have made a diary of your periods and the amount of bleeding in each month. Your GP will examine your abdomen and undertake an internal examination. Your GP may check to see if you are anemic. If these examinations are normal no further tests are needed.

Tests done at hospital
If initial tests are abnormal or treatment with tablets has not been successful your GP will seek help at Brighton and Sussex University Hospital.

Q: How is heavy menstrual bleeding treated?

The following treatments can be suggested and prescribed by your own doctor. There are further treatment options that can be offered by the hospital, and your own doctor will be able to give you more information about these.

Not treating
This is an option if your periods do not interfere too much with normal life.

Tablets

  • Ponstan ( Mefenamic Acid ® ) if taken regularly during a period reduces levels of the chemicals in the lining of the womb that cause the bleeding. It can reduce the blood loss by 20-50%. It has to be taken three times a day during the period.
  • Cyclokapron ( Tranexamic acid ® ) acts by sealing the blood vessels in the lining of the womb and can reduce the blood lost by half. It is taken three times a day during the period.
  • Combined oral contraceptive pills turn off the ovaries and so stop periods. The usually light bleeding at the end of each packet is caused by the drop in hormone levels during the 'pill free week'. Bleeding is often 20% lighter.

Intrauterine contraceptive system (IUS, Mirena ® )

  • In the past coils made your periods heavy. An IUS is a coil which is impregnated with hormone. Virtually no hormone is absorbed into the body and so you will have few hormonal side effects. This system can reduce bleeding or stop them altogether. There may be some bleeding between periods for the first few months. 60-70% of women are delighted with the effect the IUS has on their periods. In addition it is more effective at preventing pregnancy than sterilization.

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