Heavy bleeding can disrupt your daily life and can be quite distressing. What causes it, how heavy bleeding is diagnosed and what treatments are available are all discussed.
What is heavy bleeding?
Heavy menstrual bleeding (also known as menorrhagia) is excessive and/or prolonged menstrual bleeding. The amount varies from woman to woman and can change at different stages in your life, for example, approaching menopause. It is defined as blood loss greater than 80ml (equal to 1/3 of a cup) per cycle, or periods lasting more than seven to eight days. Heavy menstrual bleeding affects about one in five women and is a common problem in the 30-50 year old age group.
How do you know if your bleeding is too heavy?
It is very difficult to determine whether your bleeding is too heavy. The best guide is to decide whether your period is impacting on your quality of life, causing you to be housebound, interrupting your daily activities or causing you stress and anxiety. The following signs may indicate you are experiencing heavy bleeding:
- Bleeding or ‘flooding’ not contained within a pad/tampon (especially wearing the largest size)
- Changing a pad/tampon every hour or less
- Changing a pad overnight
- Clots greater than a 50 cent piece in size
- Bleeding for more than 7-8 days
How can heavy bleeding affect you?
- feel fatigued, exhausted, dizzy and look pale
- have low iron levels because of the blood loss
- have cramping and pain in the lower abdomen
- have to change sanitary products very frequently
- fear bleeding through to your clothes and this affects your daily activities
In more than half of cases menorrhagia has no obvious cause. However, it is sometimes related to the presence of disease. Known causes include:
- Fibroids: benign enlargements of muscle in the wall of the womb
- Endometrial polyps: benign outgrowths of the lining of the womb
- Endometriosis: misplaced tissue in the lining of the womb
- Pelvic inflammatory disease: ongoing infection of the pelvis
- Polycystic Ovarian Syndrome (PCOS)
- Cancer of the womb lining (Endometrial Carcinoma)
Other causes of irregular and heavy bleeding may be:
- Abnormal hormone cycles
- Blood clotting disorders (rare)
- Thyroid gland problems – (also rare)
- Intra-uterine contraceptive devices (IUCDs)
- Oral contraceptive pills, in some women
- Sterilization undertaken by tying of the fallopian tubes
In cases of abnormal bleeding it is important to discover if there is any underlying problem in the pelvis. This is done by means of a simple pelvic examination. The doctor inspects the vulva, vagina and cervix (neck of the womb) to make sure there is no abnormality that could account for the bleeding. At the same time the doctor can check for signs of other conditions such as fibroids or endometriosis.
Sometimes further tests are needed.
These may include:
- Transvaginal ultrasound scan: This is likely to be the first investigation
- Endometrial biopsy: A piece of the womb lining is taken and examined under a microscope
- Hysteroscopy: A similar tube is passed through the neck of the womb so that the womb cavity can be examined
- Laparoscopy: A viewing tube is passed through a small incision below the naval, allowing the doctor to look at the outside of the womb, ovaries, fallopian tubes and other pelvic organs. Hysteroscopy is likely to precede laparoscopy
- Measuring menstrual blood loss: The quantity of menstrual blood can be measured by weighing a dry then wet tampon or sanitary pad.