WHAT CAUSES HEAVY PERIODS (Menorrhagia)?

What is a heavy period?
What causes heavy periods?
Investigations and diagnostic procedures
Treatment with medication
Treatment with surgery

If you are worried about heavy menstrual bleeding:

• See your gynaecologist (specialist in women’s health).
• Talk to them about the changes to your period.
• Tell them about any medications or contraceptives you are using.

What is a heavy period?

Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman’s physical, social or emotional quality of life.

A period is heavy if you are:

• passing lumps of blood (or large clots) 
• bleeding so much that you have to change your pad every hour 
• having to get up most nights to change your pad
• bleeding that lasts more than eight days.

Heavy periods can lower your iron levels and red blood cells so you may:

• feel tired more easily 
• feel weak or dizzy
• be short of breath and have chest pains.

What causes heavy periods?

The more common reasons for heavy periods are:

• fibroids
• polyps
• endometrial hyperplasia
• endometrial cancer
• adenomyosis

There are several other possible causes of menorrhagia, including:

• Hormonal imbalance
• Pelvic inflammatory disease (PID)
• Certain birth control devices; i.e., intrauterine devices (IUDs)
• Bleeding disorders, Liver, kidney or thyroid disease

Investigations and diagnostic procedures

A diagnosis can only be certain when your gynecologist has ruled out other menstrual disorders, medical conditions or medications that may be causing or aggravating the condition. 

Diagnostic procedures may include:

• Blood tests
• Pap test
• Ultrasound.
• Magnetic resonance imaging (MRI) to produce detailed images of the reproductive organs.
• Hysteroscopy: A visual examination of the canal of the cervix and the interior of the uterus using a hysteroscope inserted through the vagina.
• Biopsy (endometrial): Tissue samples are removed from the lining of the uterus to determine if cancer or other abnormal cells are present.

Treatment with medication

A specific treatment plan will be determined by your doctor based on factors such as:

• Your age, overall health and medical history
• Extent of the condition
• Possible cause of the condition
• Current symptoms
• Your tolerance for specific medications, procedures or therapies

Discussing your menstrual disorder symptoms with your doctor can help determine what type of treatments can best reduce or relieve your symptoms, including:

• • Prostaglandin inhibitors
  • Hormone supplements
  • Oral contraceptives

• Hormone-releasing intrauterine device (IUD) 

• Vitamin or mineral supplements & Dietary modifications
•  

Treatment with surgery

If you have tried medication treatments for your heavy periods with no improvement, surgery may be your next option.

You may consider surgery if you:

• tried medication but it didn’t help
• could not try medication because of other health issues
• have fibroids
• have other conditions which cause bleeding and pain (e.g. endometriosis).

Surgery aims to stop bleeding and pain completely by removing or reducing the cause (fibroids, polyps or the lining of the uterus) or by removing the uterus completely.