Heavy Periods (Menorrhagia)

How do you differentiate between normal and heavy periods?

Definition of normal can be different for different people. However, you can call your periods heavy, if you are passing lots of clots or having to constantly use double protection, changing protection more frequently than every four hours or if your periods are making you anaemic.

How common are heavy periods?

Heavy periods are very common and nearly 50% of women suffer from heavy periods at some stage of their life.

What are the common causes?

  • Uterine fibroids:  Fibroids often present with heavy periods.
  • Endometriosis:  Endometriosis can cause heavy and painful periods.
  • Polycystic ovaries:  Periods can be less frequent but heavier.
  • Perimenopausal changes:  A few months / years before menopause, the periods can change pattern and become heavier.
  • Endometrial hyperplasia and cancer:  This can be a rare cause of menorrhagia.

What tests are required?

  • Blood tests: These are required to check your haemoglobin (to make sure that you are not anaemic) and thyroid function.
  • Ultrasound scan:  To check the uterus (womb) lining and to look for other causes as listed above.
  • Endometrial biopsy:  This may be indicated particularly in women over the age of 40.
  • Hysteroscopy:  This is camera examination of the uterus. This can be carried out under local or general anaesthesia.

What are the treatment options?

  • Contraceptive Pill:  This is appropriate if you also need effective contraception. The pill will often make the periods lighter.
  • Tranexamic Acid:  This medication is taken during periods, and will reduce the heaviness of periods.
  • Mefenamic Acid:  In addition to making periods lighter, this medication is also good for relieving spasmodic period pains.
  • Mirena Coil:  This popular intra-uterine device provides effective contraception, but also releases a small amount of progesterone hormone and often helps with heavy periods. In some women the periods completely stop, while in majority, periods become much lighter. Effective for five years.
  • Endometrial ablation:  Lining of the uterus can be treated with electrical, heat or microwave energy and will then be replaced by fibrotic tissue which does not bleed as much. Appropriate when family is complete.
  • Treatment of cause:  If fibroids are present, they can often be removed through key-hole approach (hysteroscopy or laparoscopy). Sometimes, an open operation may be required.
  • Hysterectomy:  This is now rarely needed to treat heavy periods, but if required is often performed as a key-hole procedure.