Heavy Periods

Heavy periods

If you’re experiencing heavy periods, you should see a doctor so that your medical history can be recorded and an examination can be performed. For sexually active women, you should make sure you have a Cervical Screening Test (CST) once every five years. An ultrasound scan is also a good idea, looking for physical problems such as fibroids (balls of fibrous tissue and muscle that bulk-up the uterus).

What are heavy periods?

On the first day of menstruation, it is mostly tissue that is secreted from the body. After that, the blood lost comes from exposed blood vessels and this is where a period can become problematic. During a normal period, around 40ml of blood is lost. During a heavy period, somewhere between 60 and 80ml of blood is lost.

Blood loss is not typically measured during a period and the diagnosis is made based on symptoms, examination findings and investigations. Heavy periods can be particularly concerning if they result in anaemia or low iron levels.

What causes heavy periods?

In most cases, no obvious cause can be found. However, some of the known causes include:

• Fibroids: usually a non-cancerous ball of fibrous tissue in the muscle wall of the womb
• Adenomyosis: where the tissue lining the inside of the womb is found growing into the muscle wall of the uterus
• Polyps: usually a non-cancerous growth inside the womb or on the cervix
• Endometrial hyperplasia: thickening of the lining of the womb
• Hormonal irregularities
• Bleeding disorders: predisposing an affected person to excessive bleeding/bruising
• Pelvic Inflammatory Disease (PID): infection of the pelvis
• Endometriosis: where the tissue lining the inside of the womb is found elsewhere in the pelvis
• Thyroid problems
• Polycystic ovarian syndrome (PCOS)
• Certain types of contraception
• Blood thinning medications
• Cancer

How do I know if I have heavy periods?

Symptoms commonly include:

• Soaking through a pad or tampon in an hour or less
• Passing blood clots during the period
• Having to wear both a tampon and pad at the same time
• Flooding onto underwear, clothes or bedding
• Feeling faint, dizzy or short of breath
• Marked tiredness and lethargy

How are heavy periods treated?

There is a range of treatment options, and the best one for you will depend on your age and reproductive needs. The good news is that in most cases a surgical approach can be avoided.

Tranexamic acid

Tranexamic acid helps stop blood clots from breaking up within the womb and therefore reduces the amount of blood lost during a period. The dose is usually two tablets taken three to four times a day on the heavy days of menstruation. It typically halves menstrual blood loss and side effects are relatively uncommon. This particular treatment may not be suitable if you have a history of blood clotting problems or kidney disease.

Anti-inflammatory drugs

These include Ponstan^® and Naprogesic^® and are best known for helping to relieve period pain. However, if a full dose is taken con­tinuously for the first five days of menstruation, they can reduce blood loss by around 25%.

The contraceptive pill

Taking the Pill is an effective method of birth control and can reduce menstrual blood loss by 30-50%.

The Mirena® device

A highly effective form of contraception, this device can also reduce blood loss during menstruation by as much as 90%. After the initial insertion, bleeding is typically irregular for around three to six weeks, but then after that periods stabilise. We are able to insert the device and use our own specialised anaesthetic gel, Pluscaine®, to numb and dilate your cervix to make the procedure as comfortable as possible for you, while eliminating the need for local anaesthetic via a needle. This is a service unique to WHRIA.

Progestins

Progesterone is a female hormone that thins the lining of the womb and helps to reduce menstrual blood loss. It can be given as tablets, vaginally or as an injection and can also substantially reduce menstrual blood loss. Around one in eight women will experience side effects with progestins such as mood swings, bloating, irritability and even depression.

Surgical

Surgery should be considered a ‘last resort’ in treating heavy periods and we will only recommend it in extreme circumstances. There are a number of operations with different rates of effectiveness and varying levels of risk, summarized below.

Removal of polyps: a polyp is a non-cancerous growth in the womb that can be the cause of heavy periods. A camera is inserted inside the womb and the polyp is identified and removed.

Myomectomy: fibroids causing heavy blood loss are surgically cut out from the wall of the womb.

Endometrial ablation: the lining of the womb is treated so that it can no longer bleed during your period. The exact method of treatment will vary from patient to patient.

Hysterectomy: the surgical removal of the womb.

Please note: Any medical or surgical procedure carries risks. Use these 5 questions to ask your doctor or other healthcare provider to make sure you end up with the right amount of care — not too much and not too little (accessed from Choosing Wisely Australia – An initiative from NPS MedicineWise).

Helpful resources

If you’d like to read more about heavy periods, what causes them and how they can be treated, please take a look at one of our Health Information Fact Sheets here.

• The Royal Women’s Hospital