Heavy Menstrual Bleeding
Heavy Menstrual Bleeding (HMB) is a common problem, affecting almost 1 in 3 women. It is one of the commonest reasons why a woman would visit their GP or gynaecologist. While it is almost never life threatening, it can cause a lot of problem to a woman – physically, emotionally, and socially.
HOW HEAVY IS HEAVY PERIOD?
Every woman bleeds different amount during their period and have different perception of how much they bleed. Some women need to change pads every 1-2 hours during their period, passing clots, and think that their period is ‘normal’, while others bleed less and feels that their period is heavy. Heavy period is a problem when the woman feels that it is a problem for them. Heavy period is also often associated with painful period. If you feel that you are tired, stays at home because of fear of pain or heavy bleed during your period, feels embarrassed at work, it is a problem that needs to be addressed.
WHAT CAUSES HEAVY PERIOD?
There are many causes of heavy period. The commonest cause is hormonal imbalance – also called dysfunctional uterine bleeding (DUB). Hormonal imbalance is difficult to measure and define, as hormone levels (oestrogen and progesterone) changes throughout menstrual cycles, and its levels differ between individuals. DUB is common at the start of puberty (in teenagers) and before menopause (women in their forties).
Other causes of heavy periods include:
fibroids (benign growth in the uterus)
endometriosis and adenomyosis (especially when associated with pain)
polycystic ovarian syndrome
clotting disorder (when it is more difficult for the blood to clot in the body)
infection (such as chlamydia)
and endometrial hyperplasia or cancer (uncommon cause of heavy period but very important one to rule out).
This is an extensive list, but your doctor would usually organize blood tests and ultrasound to detect many of these problems. Others might need further investigations to diagnose.
WHAT TESTS ARE THERE TO FIND OUT THE CAUSES OF HEAVY PERIOD?
Ultrasound of the pelvis – looking at the uterus, its internal lining, and ovaries is probably the most useful test. It may be able to detect fibroids, polyps, endometriosis and adenomyosis (if severe).
Blood tests may be organized by your doctor to look out for hormonal levels (such as in polycystic ovarian syndrome), clotting disorders, and also blood count and iron storage (to look out for anaemia).
Swabs are taken if infection is suspected. Cervical screening test (routine screening test for cervical cancer) is taken if overdue (now done every 5 years in Australia).
Sampling of the internal lining of the uterus may be required in women with higher risk of endometrial hyperplasia (overgrowth of internal lining of uterus) or cancer.
Risk factors for this include:
age over 40
not ovulating regularly – such as in polycystic ovarian syndrome.
Even though this is an uncommon cause of heavy period, it is important not to miss.
WHAT TREATMENTS ARE THERE TO HELP REDUCE OR STOP HEAVY MENSTRUAL BLEEDING?
The good news is heavy period can mostly be treated quite easily. There are many treatment options, and there is hopefully one to suit you. The treatment can generally be offered through medication or surgery.
Medications to reduce heavy period include NSAID (anti-inflammatory medication) such as Ponstan.
Other commonly used medication is OCP (oral contraceptive pill). Women taking the pill usually have lighter periods. Another commonly used treatment is an intrauterine device (IUD) that releases small amount of progesterone to thin out internal lining of the uterus.
If polyps or fibroids are causing the heavy period, these need to be removed through operation.
Other surgical options include:
endometrial ablation (burning of the internal lining of the uterus)
hysterectomy (removing the uterus – usually without removing the ovaries).
These surgeries are not suitable to women wanting to preserve their fertility.
Even though these operations have high success rates, any operations have associated risks, and are therefore the last resort when all other treatments have failed.
These treatment options are offered depending on your age, your medical condition, your fertility wishes, and personal preference.