Menorrhagia (Heavy periods)
Heavy periods are common. Most of the time no cause can be found, but in some cases a cause is found and can be treated. In most cases, the treatment is either with medications or surgery.
What is menorrhagia?
About 1 in 3 women describe their periods as heavy. However, it is often difficult to know if your periods are normal or heavy compared with other women. Menorrhagia means heavy periods that recur each month and interferes with your quality of life.
What causes heavy periods?
The cause is not known in most cases. This is called dysfunctional uterine bleeding and is the cause of heavy periods in 4 to 6 out of 10 cases. In this condition, the womb (uterus) and ovaries are normal.
Other causes are:
Fibroids: These are benign (non-cancerous) growths in the muscle of the uterus. They often cause no problems, but sometimes cause symptoms like heavy periods.
Other conditions of the uterus: such as endometriosis, infections or polyps, may lead to heavy periods. Cancer of the lining of the uterus is a very rare cause. Most cases of endometrial cancer develop in women aged in their 50s or 60s.
Hormonal problems: Periods can be irregular and sometimes heavy if you do not ovulate every month like women with polycystic ovary syndrome. Also, women with an underactive thyroid gland may have heavy periods.
The intrauterine contraceptive device (IUCD, or coil): sometimes causes heavy periods. However, a special hormone-releasing IUCD called the intrauterine system (IUS) can treat heavy periods
Pelvic infections: There are different infections that can sometimes lead to heavy bleeding.
Warfarin or similar medicines: that interfere with blood clotting can lead to heavy periods.
Some drugs used for chemotherapy can also cause heavy 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.
If you stop taking the contraceptive pill it may appear to cause heavy periods. Some women become used to the light monthly bleeds that occur whilst on the pill. Normal periods return if you stop the pill. These may appear heavier, but are usually normal.
Do I need any tests if I have heavy periods?
A blood test to check for anaemia is usually performed. Heavy periods can lead to anaemia which can cause tiredness and other symptoms.
An ultrasound scan this can detect any fibroids, polyps, or other changes in the structure of your uterus.
Internal swabs This may be done if an infection is the suspected cause of the heavy bleeding.
Endometrial sampling This is more likely to be done if you are aged over 45 years, have persistent bleeding or have tried treatment without it helping.
Hysteroscopy This is where a doctor can look inside the uterus. This can often be done without an anaesthetic. Small samples can also be taken during this test.
Other blood tests You may need other tests if an underactive thyroid gland or a bleeding disorder is suspected.
What are the treatment options for heavy periods?
Treatment aims to reduce the amount of blood loss. Treatment options are different if an underlying cause for heavy periods is found like fibroids or endometriosis.
This is an option if your periods do not interfere too much with your normal life. You may be reassured that there is no serious cause for your heavy periods, and you may be able to live with them. A blood test may be advised every so often to check for anaemia.
Levonorgestrel intrauterine system (LNG-IUS)
This treatment usually works very well. The LNG-IUS is similar to an intrauterine contraceptive device (IUCD, or coil). It is inserted into the womb (uterus) and slowly releases a small amount of a progestogen hormone called levonorgestrel. Period pain is usually reduced too. The LNG-IUS works mainly by making the lining of the uterus very thin.
Tranexamic acid tablets
Tranexamic acid tablets are an option if the LNG-IUS is not suitable or not wanted. Treatment with tranexamic acid can reduce the heaviness of bleeding by almost half (40-50%) in most cases. If side-effects occur, they are usually minor and may include an upset stomach.
Your doctor may prescribe ones called Mefenamic acid or Naproxen. These medicines reduce the blood loss by about a third (20-50%) in most cases. They also ease period pain. Side-effects occur in some people and may include an upset stomach.
The combined oral contraceptive pill (COCP) This reduces bleeding by at least a third in most women. It often helps with period pain too. It is a popular treatment with women who also want contraception, but who do not want to use the LNG-IUS.
Long-acting progestogen contraceptives
The contraceptive injection and the contraceptive implant also tend to reduce heavy periods. For example, up to half of women on the contraceptive injection have no periods after a year. They are not given as a treatment just for heavy periods. However, if you require contraception then one of these may be an option for you.
Norethisterone is a progestogen medicine. It is not commonly used to treat heavy periods. It is sometimes considered if other treatments have not worked, are unsuitable or are not desired by patient.
It is an option if the above treatments do not help or are unsuitable:
Endometrial ablation or resection. Removing or destroying the lining of the uterus is an option. This treatment prevents women from having children in the future. However there have been some pregnancies in otherwise fertile women, so it cannot be used as contraception.
Hysteroscopic resection of fibroids and polyps. Treating the underlying cause like removing the intracavitary fibroid or polyp can help with the heavy periods.
Hysterectomy is the traditional operation where the uterus is totally removed. It may be considered if all other treatment options have not worked for you.