Heavy Periods (Menorrhagia) – Risk, Causes, Measures and Treatment

Heavy periods are heavier than normal menstrual periods. The name we give to unusually heavy menstruation is menorrhagia.

Menorrhagia could be a single bout of flooding, a period that goes on for a long time (more than seven days) or very frequent periods so that the blood loss in any given month is excessive.

The main problem in diagnosing heavy menstruation is differentiating between bleeding that’s heavier than you’re used to, and heavy bleeding that’s abnormal. In a normal menstrual bleed 30-50ml (1-2 fl oz) of blood is lost, whereas in an abnormal bleed 80ml (2-3 fl oz) or more is lost.

Who Is At Risk of Heavy Periods?

Menorrhagia is common and may affect the ■ following groups:
• women approaching the menopause – the lining of the womb becomes extremely thick and there’s a heavier blood loss as the lining is shed
• women who have been fitted with an IUD, which increases blood loss
• women with fibroids, because they increase the surface of the womb and its lining.

What Causes Heavy Periods?

Heavy periods are due to the absence of progesterone, the hormone that’s responsible
for controlling menstrual blood loss. It usually means that ovulation is failing. As a result the uterine lining builds up until finally it breaks down naturally, resulting in a heavy, uncontrolled bleed.

Bleeding of this type that occurs around the time of the menopause can often be successfully treated using certain types of hormone replacement therapy (HRT).

Measures of Heavy Periods

Normally a doctor will want to exclude any womb problems and check on normal blood clotting. The following will be carried out:

• blood tests
• a general gynaecological examination
• an ultrasound scan
• if the ultrasound reveals any abnormality, the uterine lining should be checked to exclude cancer by the removal of small samples of the lining.
• if the bleeding has an unusual pattern as well as being heavy, a doctor may decide to look directly inside the uterus in a procedure called hysteroscopy under a general anaesthetic.

What Is The Treatment of Heavy Periods?

FIRST OPTION
Drugs are the first option in the treatment of menorrhagia – NOT a hysterectomy.
A woman may be prescribed a clotting drug, such as tranexamic acid, which will help her uterus to stop bleeding. Hormones, such as progestogen and the combined contraceptive pill, may control bleeding. Less effective, but sometimes helpful, are the antiprostaglandin group of drugs, for example mefenamic acid.

A new form of hormone treatment has just become available that will be a boon to women with heavy bleeding. It’s a progestogen IUD, known as the IUS. The ILTS alters hormone levels less drastically than the combined pill, so there are few side effects. It seems ideal for women who have had their children because:

• it cures the heavy bleeding
• it’s a virtually 100 percent effective contraceptive
• it remains during the menopause and is part of your HRT treatment.

HYSTERECTOMY SHOULD BE SEEN AS A LAST RESORT AND IF YOUR DOCTOR ADVISES IT, GET A SECOND OPINION.

SECOND OPINION

Hysteroscopic transcervical resection (TORE)

The cavity of the womb is viewed using a small telescope that is inserted via the vagina and cervix. At the same time, the lining of the w can be removed using an electrical loop. TI way periods are minimized or even stopped completely and no abdominal surgery is involved. There are many advantages to TCI

■ It’s an alternative to long-term drug therapy
■ The major surgery of a hysterectomy is avoided.
■ Hospital stay and recovery time much muc shorter than for hysterectomy.
■ There s no surgical incision and therefore no scar.

Uterine Balloon Therapy

The latest treatment for menorrhagia is still a research procedure that is performed under local anaesthesia. It aims to destroy the lining of the uterus with heat and so make periods lighter. It’s not available everywhere.

A soft flexible balloon attached to a thin catheter is inserted into the vagina through the cervix and placed in the uterus. The balloon is inflated with a sterile fluid and heated to 87°C (188°F) for about 8 minutes.
After treatment you have a period over the next 7-10 days.

SELF-HELP

Claims are made for certain foods and supplements but there is no proof of their usefulness. Bioflavonoids, which are found in citrus fruits, are said to alleviate heavy bleeding. Regular strenuous exercise and keeping weight down may also be helpful. Avoiding alcohol may help relieve menorrhagia, since heavy drinking can inhibit the formation of blood platelets, which means blood does not clot as well as it should and may flow more profusely during menstruation. The same is true of aspirin. Hot showers or baths during menstruation can also increase bleeding because heat dilates the uterine blood vessels and increases flow. Your blood should be checked regularly for signs of anaemia and if your haemoglobin is low you should eat more iron-rich foods such as nuts, liver, red meats, egg yolk, green leafy vegetables and dried fruits.