Heavy periods (menorrhagia)
Reviewed by Dr Philip Owen, consultant obstetrician and gynaecologist
What are heavy periods?
The correct medical definition of heavy periods is the passage of more than 80ml of blood each period. It is seldom realistic or practical, however, to actually measure the blood loss and so doctors rely on the woman's description of her period.
Periods are considered heavy when:
- a woman bleeds for more than 8 to 10 days, especially if this is repeated month after month.
- a woman bleeds so much that it is difficult for her to attend her job. She may be forced to plan her holidays and leisure time according to the timings of her period.
- the bleeding is continuously so heavy that the woman becomes anaemic.
- the presence of other than small clots for more than one or two days suggests heavy periods.
- 'flooding' describes the sudden, unexpected onset of periods, like turning on a tap, and indicates heavy periods.
Why do some women have heavy and long menstrual flows?
The causes of prolonged and heavy bleeding are given below.
- In younger women heavy periods are most often due to a temporary hormone imbalance, which eventually corrects itself.
- In the years close to the menopause, (45 years of age onwards) heavy periods are usually a sign of hormone imbalance. However, the possibility of heavy periods being caused by an underlying disease increases with age.
The following conditions are associated with heavy periods:
Is it necessary to consult a doctor?
If a woman is experiencing heavy or irregular periods that are interfering with her quality of life, then she should consult a GP or gynaecologist.
What will the doctor do?
A pelvic examination is usually necessary. If the woman is over 40 years of age, then a pelvic ultrasound scan or a biopsy of the lining of the womb is appropriate. This is to ensure that there is no abnormality with the cells of the lining of the womb.
An examination called a hysteroscopy is often suggested. This involves placing a fine telescope through the neck of the womb so that the lining of the womb can be seen. Most hysteroscopies are performed without the need for general anaesthesia.
How are heavy periods treated?
If there are no signs of an underlying abnormality, treatment is not absolutely necessary but most women prefer to have something to help them cope more easily each month.
- If the problems are severe, bleeding may be regulated by tablet treatment. These may be hormonal or non-hormonal.
- Hormonal treatments include the contraceptive pill and danazol (eg Danol).
- Progestogens are effective in making a woman's periods more regular but do not reduce the monthly flow.
- Non-hormonal treatments include tranexamic acid (eg Cyklokapron), which reduces the blood loss by up to half.
- Non-steroidal anti-inflammatory drugs (NSAIDs) reduce monthly loss by about a third.
- Alternative approaches include the use of a hormone containing contraceptive coil (Mirena), which is suitable for most women.
- Surgical alternatives include destroying the lining of the womb with a laser or applying heat treatment to the lining of the womb with hot water in a balloon. Hysterectomy - the removal of the uterus - is commonly performed for heavy periods. These two surgical procedures are only appropriate for women who do not wish to have any more children.
- If a diagnosis of an underlying condition is made, then the treatment will be tailored towards that condition.
- If the woman is anaemic, iron or folic acid supplements may be needed.
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