What Causes Heavy Menstrual Bleeding?

What Causes Heavy Menstrual Bleeding?

If you’re anything like me, you probably accept some pain and feeling tired when you are on your period and consider it pretty normal. But if you experience heavy periods and, or severe pain, this could be a sign of more serious underlying health conditions.

This post explores the causes of heavy menstrual bleeding and the available treatment options. It’s time to stop coping with heavy periods and period pain and start living your life as you want!

What Are Heavy Periods?

If you are unsure if your periods are heavy, there are seven key signs:

1. Large blood clots, which can be lumpy, stringy or look similar to blobs of gel
2. Changing period protection more often than recommended by the product
3. Using two types of period protection, such as tampons and pads
4. Bleeding through period protection
5. Needing to change period protection during the night
6. Bleeding for more than seven days
7. Feeling extremely tired and unable to work or carry out daily activities.

Causes of Heavy Periods

You may be surprised to learn that you can not always determine the actual reason for heavy menstrual bleeding. This does not mean there are no effective treatment options, simply that the underlying cause is not established following diagnostic tests.

12 Causes of Heavy Bleeding

1. Hormone imbalance, which may be due to various conditions, including: ovary dysfunction, insulin resistance, thyroid disorders and obesity.
2. Polycystic ovary syndrome (PCOS), you may also have other signs of this in addition to heavy periods, such as irregular periods or excess body hair.
3. Fibroids (benign tumours) grow inside the muscle in the uterus wall and are one of the most common reasons for heavy bleeding. Up to 80% of women will have had fibroids by the time they are age 50. In addition to heavy periods, you may feel pressure or pain in your abdomen.
4. Polyps (uterine polyps) are small benign masses that grow inside the uterus lining. Another sign of polyps is spotting in between periods.
5. Endometriosis is uterus cells growing outside of the uterus. Other signs of endometriosis include: pain during sex, severe menstrual cramps, constipation and lower back pain just before or during your period.
6. Pelvic Inflammatory disease (PID) is an infection in a woman’s reproductive organs. Additional symptoms are: lower abdominal pain, high temperature, nausea and vomiting and pain during intercourse.
7. Intrauterine device (IUD) is more common with a non-hormonal IUD.
8. Adenomyosis iswhen uterine tissue grows into the muscle of the uterus. This condition can also cause painful periods.
9. Medications may be the reason for heavy periods, including: Hormonal treatments or contraceptives, such as progestin and oestrogen, Anti-inflammatory drugs (NSAIDs), Anticoagulants (blood thinners), Corticosteroids are often referred to as steroid injections, but may also be taken in tablet form or via a nasal spray, skin cream or gel, Tamoxifen (brand name Nolvadex) is used for the treatment of breast cancer, Antidepressants and antipsychotics, Herbal medicine, such as ginseng tablets.
10. Cancer, endometrial, cervical and uterine cancer can cause heavy menstrual bleeding. Other symptoms include: pain during sexual intercourse, abdominal pain, heavy vaginal discharge in between periods and unexplained weight loss.
11. Immune thrombocytopenia (autoimmune bleeding disorder) is a condition that affects blood clotting. Other signs are: nosebleeds, cuts that bleed excessively and bruising.
12. Health conditions, such as kidney or liver disease.

Infertility and Heavy Menstrual Bleeding

Ignoring heavy or prolonged menstrual bleeding could result in infertility or increase the risk of miscarriage if the cause is left untreated.

Causes of infertility include:

• Polycystic ovary syndrome (PCOS)
• Endometriosis
• Cancer and cancer treatment
• Fibroids
• Polyps
• Pelvic Inflammatory disease (PID)
• Adenomyosis

Anaemia and Heavy Menstrual Bleeding

Heavy or prolonged bleeding may lead to low red blood cells (RBC) and cause iron deficiency anaemia.

Symptoms of anaemia include:

• Chronic fatigue
• Heart arrhythmia (irregular heartbeat) or fast heartbeat
• Shortness of breath
• Dizziness
• Fainting
• Headaches
• Difficulty concentrating
• Loss of appetite
• Feeling cold and, or cold hands and feet.

Treatment for iron deficiency anaemia is normally provided in the form of iron supplements. If you have a very low iron level or cannot absorb iron, you may require an iron transfusion via an intravenous (IV) drip. This is normally given in a hospital, and you go home the same day. Occasionally, you may need multiple iron transfusions.

Diagnosing the Cause of Heavy Bleeding

It is helpful if you have a record of your menstrual cycle over three or more months. Record the date you start to bleed, any days you don’t bleed, and the date you stop bleeding. Note what period protection you use and how often you need to change it. You may find it easier if you use a period-tracking app. However, you can record it in a diary. 

Diagnostic tests, such as an ultrasound or magnetic resonance imaging test (MRI), may be required to investigate the cause of heavy menstrual bleeding. If the cause can not be established, additional tests may include:

• Transvaginal ultrasound involves inserting a wand-shaped ultrasound probe inserted into the vagina.
• Hysteroscopy is usually performed with local anaesthetic and involves inserting a thin, lighted scope called a hysteroscope through the cervix to look inside the uterus.
• An endometrial biopsy involves taking an endometrium sample of cells and might be performed with a hysteroscopy or dilation and curettage (D&C).
• Sonohysterography fluid, a small tube is inserted into the cervix to fill the uterus with fluid. Next, an ultrasound is conducted to generate digital images of the uterus cavity and lining.

Treatments and Surgery for Heavy Bleeding

You can treat heavy bleeding in various ways. Hormonal treatment is usually tried before any surgical procedure. The type of hormones will depend on the condition being treated.

Hormone treatments for heavy periods include:

• Gonadotropin-releasing hormone (GnRH) tablets can treat large fibroids and stop you from having periods.
• An intrauterine device (IUD), known under the brand name Mirena, is a coil that releases hormones and is a form of birth control.
• Hormone replacement therapy (HRT) may be used during the perimenopause stage. Before using hormone therapy, weighing up its risks and benefits is crucial. For instance, there is an increased risk of stroke, cancer, and heart attack.
• Another treatment is Tranexamic acid tablets which are only available on prescription and are taken daily during your menstrual cycle.

Surgical Procedures Used to Treat Heavy Bleeding

The surgical procedure you need will depend on the condition being treated. Standard procedures to treat heavy periods are:

• Endometrial ablation destroys the endometrium (uterus lining) and can reduce or completely stop menstrual cycles. This is likely to prevent you from being able to get pregnant. Additionally, if you manage to conceive, the risk of miscarriage and complications is higher following endometrial ablation.
• Myomectomy to remove fibroids and preserve the uterus. This procedure may increase your chance of conceiving.
• Uterine artery embolization (UAE) blocks the blood vessels that lead to the uterus to shrink fibroids by cutting off their blood supply.
• Oophorectomy to remove the ovaries.
• Hysterectomy to remove the uterus. Read this article to find out what to except in the first week after having a hysterectomy.

There are several minimally invasive ways these procedures can be performed including laparoscopically, also referred to as keyhole surgery and transvaginally.

Private Treatment for Heavy Periods

If you want private treatment, deciding where to go can be very daunting. You can start by speaking to your GP and requesting a gynaecologist referral. Another way to find private treatment is to search for private hospitals with well women clinics. The London Wellwoman Gynaecology Clinic team at St John & St Elizabeth Hospital specialises in diagnosing and treating all gynaecological conditions.

Guest Article.