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Defining a heavy period is not as easy as it seems. Although the volume of blood loss can be measured, it is not easy and is rarely done outside of clinical trials. Doctors usually rely on a woman's perception of her menstrual loss, even though a significant number of women complaining of heavy periods can be shown to have normal blood loss when it is measured accurately. Periods may be considered heavy if the flow is brisk or prolonged.
If you have heavy periods then you should see your GP who will examine you and decide whether investigation is required. He/she may organise a blood test to exclude anaemia and a pelvic ultrasound scan. GPs are perfectly capable of managing most women with heavy periods. Common reasons for referral on to a gynaecologist include severe anaemia, prolonged bleeding / bleeding in between periods, especially in a women over the age of 40, large fibroids or a thickening of the lining of the womb.
Many women with heavy periods will have no readily identifiable cause. There are many treatments available for these women.
One of the most common causes of heavy periods is fibroids. Fibroids are extra pieces of muscle tissue located in the womb. They are common, affecting about 20% of women, many of whom have no symptoms from them. They are more common in women of African, Caribbean or Asian origin. They are benign and the risk of them becoming cancerous is negligible. As well as causing heavy periods, larger fibroids may cause pelvic discomfort as well as bowel / urinary symptoms due to direct pressure.
The treatment of fibroids will depend on your symptoms, age, desire for future pregnancies and the size / location of the fibroids. Most women with small fibroids can be managed with any of the common simple treatments that are available. Fibroids that protrude into the cavity of the womb may be removed during an operation known as hysteroscopy. Larger fibroids may be removed by an open operation known as a myomectomy, especially if future pregnancies are desired. A non-surgical treatment for large fibroids known as embolisation has recently been introduced with promising results. Embolisation is a technique where the blood vessel(s) feeding the fibroid are blocked using a narrow tube inserted into an artery in the groin. Embolisation is not a suitable treatment for all women and is available at relatively few hospitals.
Larger fibroids can be treated non-surgically by a procedure known as Fibroid Embolisation. Fibroid Embolisation is a technique where the blood vessel(s) feeding the fibroid are blocked using a narrow tube inserted into an artery in the groin. Embolisation is not a suitable treatment for all women and is available at relatively few hospitals.
Ulipristal (Esmya) was licensed for medium term treatment of heavy periods caused by moderate/large fibroids in 2016, Esmya is proving very popular with many gynaecologists. Further research will determine the long term effectiveness of this treatment.
Most women experience some discomfort during their periods, often taking simple painkillers like Paracetamol or Ibuprofen. More severe pain suggests the presence of endometriosis. Affecting around 6% of women, endometriosis is caused by deposits of glandular tissue around the pelvis. This tissue is hormonally responsive like the lining of the womb, intermittently swelling and bleeding, and thus causing pain. The pain typically gets worse on the week before a period and is particularly bad during a period. Intercourse often causes lower abdominal pain which may persist for an hour or so afterwards. Periods are sometimes heavy but are often not so. It can be a cause of infertility although the reasons for this in women with mild disease are not understood. Vaginal examination can reveal pelvic swellings and scarring, but there is usually just some tenderness on movement of the womb.
An ultrasound scan is often performed to look for endometriotic cysts in the ovaries and to exclude other causes of pain. Laparoscopy can be performed to confirm the diagnosis also to treat the condition by destroying or removing the endometriotic tissue.
Periods commonly become frequent (eg. every 2-3 weeks) because of a hormonal imbalance (doctors call this dysfunctional uterine bleeding). This warrants investigation in women over 40. Where the periods are prolonged such that there is no real bleeding pattern, this warrants urgent investigation in women of any age, as there may be a serious cause such as infection, cancer of the cervix / womb or an unrecognised pregnancy.
Although the normal menstrual cycle is often considered to be 28 days, it is considered normal for it to last between 25 and 35 days. Remember - always count from the first day of one period to the first day of the next.
Infrequent / absent periods
The occurrence of periods less often than every 35 days is called oligomenorrhoea. When periods occur less often than once every 6 months, the condition is known as amenorrhoea. Women with infrequent periods are unlikely to be ovulating regularly and are therefore likely to have difficulty conceiving.