Heavy Menstrual Bleeding

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• Heavy Menstrual Bleeding

Medically Reviewed April 2023, by Mr. Bryan Mayou (GMC: 1414396) - founder of the Cadogan Clinic and one of the world's leading plastic surgeons

What are the causes of heavy periods?

There are a number of causes of heavy periods.

• Endometriosis: In endometriosis, tissue similar to that found in the uterus starts growing where it shouldn’t be, for example on the ovaries or fallopian tubes. This can be incredibly painful and lead to heavy and irregular periods.
• Fibroids: Fibroids are non-cancerous growths made up of muscle and fibrous tissue that develop in or around the uterus.  They vary in size from the size of a pea up to the size of a melon. Some women may not even be aware that they have fibroids, but around one in three will experience fibroids symptoms such as heavy or painful periods, abdominal or lower back pain, pain during sex, a frequent need to urinate and constipation.
• Adenomyosis: In this condition, tissue that normally lines the uterus starts to grow within the muscular wall of the uterus, causing a great deal of pelvic pain and period pain. Heavy, painful or irregular periods are common with adenomyosis.
• Polyps: Polyps are overgrown pieces of tissue protruding from the delicate skin of the cervix or the surface of the cervical canal. They are sometimes the cause of excessively heavy and/or irregular menstrual bleeding.
• Pelvic inflammatory disease (PID): PID is an infection of the female reproductive system which encompasses the ovaries, fallopian tubes and uterus. PID doesn’t always cause symptoms, but it can be responsible for painful, heavy periods.
• Anticoagulant medicines: Anticoagulant medicines, sometimes referred to as ‘blood thinners’ are used to prevent blood clots and prevent serious medical problems from developing, such as strokes, heart attacks and deep vein thrombosis (DVT). However the main side effect of anticoagulants is that they make the person taking them bleed too easily, which can cause issues such as heavy period bleeding.
• Chemotherapy: Chemotherapy is a cancer treatment where medicine is used to kill cancer cells, but it also causes a range of side effects. This can include heavy period bleeding in women.
• Womb (uterus) cancer: Developing heavy periods can be a sign of womb cancer, although this is rare.
• Stress: It should not be underestimated what stress can do to a woman’s menstrual cycle. If you're stressed, your menstrual cycle can become longer or shorter, your periods may become more heavy, more painful or even stop altogether.
• Unknown cause: Sometimes a few simple tests can find the root cause of heavy periods, but in many cases it isn’t clear why a woman suffers from heavy menstrual bleeding. As well as losing lots of blood, a woman experiencing regular heavy periods may suffer from stomach cramps and pain, affecting her quality of life.

When should I be concerned about heavy periods?

Often heavy periods are nothing to be concerned about and can be managed at home. But you should make an appointment with a doctor if you suffer from heavy period bleeding and any of the following apply to you:

• Heavy periods are affecting your life. This may mean that you avoid certain activities, for example through fear of bleeding through clothing, or your heavy periods force you to take time off work or education.
• You have severe pain during your periods. Heavy periods coupled with severe pain can be an indicator of an underlying condition such as adenomyosis or endometriosis.
• You have had heavy periods for some time.
• You bleed between periods or after sexual intercourse. This may indicate an underlying condition such as polyps or fibroids. Vaginal bleeding between periods is also a symptom of womb cancer.
• You have heavy periods and other symptoms such as pain when having sex or going to the toilet. Pelvic inflammatory disease (PID), endometriosis and fibroids can all cause pain during sex.

What treatment options are available for heavy periods?

The treatment for heavy periods really depends on what is causing the excessive bleeding. Heavy period treatment includes the following:

• Hysteroscopy: Hysteroscopy is a surgical procedure used to examine the inside of the uterus. A long, thin tube containing a light source and camera is passed into the uterus to investigate female health concerns. Fine surgical instruments can be passed along the hysteroscope in order to cut or burn away any abnormal tissue. Fibroids and polyps can be successfully treated via a hysteroscopy.
• Laparoscopy: Commonly known as keyhole surgery, laparoscopy is a minimally-invasive surgical procedure where a small incision is made in the stomach to allow a small tube with a light and camera into the body. A laparoscopy can be used to treat endometriosis and fibroids.
• Myomectomy: A myomectomy can successfully remove fibroids from the uterine wall. However this type of surgical removal is not suitable for all types of fibroids.
• Hysterectomy: On rare occasions, a hysterectomy (surgery to remove the uterus) may be required to treat conditions like endometriosis and certain gynaecological cancers. A hysterectomy is a major surgery and is usually only considered if there is no other alternative.
• Medication: Pelvic inflammatory disease (PID) can be successfully treated with antibiotics. Depending on what is causing the heavy periods, the doctor may also prescribe anti-inflammatory painkillers or medicine which can help to reduce bleeding, such as tranexamic acid.
• Contraception: Some types of contraception can help to reduce the amount of bleeding and make periods regular. This includes the combined contraceptive pill and intrauterine system (IUS).

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