Periods…..ahhhh, where would our lives be without them. For a woman it is a sign of their coming of age and their womanhood. It can however be the bane of a woman’s life. Too little, too often, too much, too little. One common scenario I do see is ..too much!
Should one be worried about periods that are too heavy? Well, yes and no. Typical man I hear you say! Sitting on the fence again. Not really.
The definition of heaviness varies from person to person. As the saying goes “One man’s ( whoops sorry..person) meat is another person’s poison”. What is deemed heavy to one may be light to another. It is thus more important for the individual to determine if there has been a change to her periods and not compare it to others. Unfortunately, such changes tend to occur over time. It is not uncommon for a woman to come to accept this change without complaining until it is really heavy, and has led to changes that affect her severely.
From a medical perspective however, there are times when periods are deemed to be too heavy. They include:
- When they cause a woman to become tired and unable to function normally
- Iron deficiency. The presence of this is frequently caused by heavy periods.
- Anaemia where the blood count is low
- When a woman complains that they are. This is important as she is the best one to notice changes as they occur.
The causes are multiple and variable. Examples are:
- Puberty or menopause are common times when the hormones play up and lead to heavier periods
- Polyps in the cavity of the womb
- Thyroid disorders
- Bleeding disorders.
You will notice that I have not mentioned “That Word”. This is because cancer is low on the listing. Usually if there is cancer, it causes funny bleeding , rather than heavy bleeding. Funny bleeding like bleeding intermittently or in between periods.
Whenever anyone comes to see me with heavy bleeding, I undertake a comprehensive assessment including a detailed history of their previous cycles. A pelvic examination offers an insight on the size of the womb to exclude fibroids. The presence of tenderness may indicate adenomyosis or endometriosis.
Investigations commonly include :
- Pelvic Ultrasound . This is an ultrasound of the womb and ovaries. It helps to check to fibroids, their location and size, adenomyosis and polyps in the cavity of the womb. Looking at the ovaries it can pick up polycystic ovaries.
- Blood tests to check for anaemia, iron levels, ovarian and thyroid hormone levels. Blood clotting tests if indicated may also be undertaken.
- Cervical screening test (Pap smear in the old lingo) . If you have not had it performed, it will be important to do so.
- D and C, hysteroscopy. This is an operation that allows me to put a telescope into the cavity of he womb to exclude polyps. This is important as not all polyps are picked up by an ultrasound. Then a curette samples the lining of the womb. This gives information about hormonal changes and any abnormal changes that may be present. This procedure is performed through the vagina. No cuts in the tummy.
- Laparoscopy. Also called keyhole surgery, it involves putting in a telescope through little cuts in the tummy to check the pelvis for conditions like endometriosis and fibroids. It is commonly combined with a D and C and hysteroscopy.
Treatment then will depend on what is found. The avenues include:
- Frequently the Oral Contraceptive Pill gives good control of the cycles and lighten bleeding. Not all can tolerate the Pill and so alternative hormone regimes can be used.
- Mirena IUD . Also hormonal, it has found a special place in management of heavy periods. Releasing progesterone over a long period of time ( 5 years) it can minimise bleeding for a majority of women, avoiding the need for more major treatments.
- Non hormonal medical therapy including Tranxenamic acid and Non Steroidal Anti Inflammatory (NSAID) medications like Ponstan and Naprogesic , offer alternatives to hormones.
- Surgery: 2 options are available namely:Endometrial ablation .
Which option is chosen will depend on:
- Severity of your symptoms
- Degree of your symptoms impacting on your daily life
- Your desire for leaving open the option for pregnancy
- Presence of any contraindication for a specific treatment option
- Your own personal wishes.
Like all things in life, nothing is either right or wrong. Finding the best way forward will need to take into account your individual circumstance and life wishes. Should you have any concerns, I would be happy to discuss this with you.
These notes reflect my personal opinion and are intended for general advice only. It should not be used for any one individual case. You should consult your own doctor to determine the appropriate management of your own individual situation. No part of these notes can be used or reproduced in any manner without my express consent