Heavy and problematic periods

Heavy periods are common, but common does not mean you should simply endure them. If your periods are interfering with work, exercise, travel or family life, or leaving you exhausted, that is reason enough to seek help.

What counts as heavy

There is no single measurement that defines a heavy period. The definition that matters most is the practical one: bleeding that interferes with your physical, emotional or social quality of life.

Signs that periods may be heavier than they should be include flooding through protection, needing to change protection hourly, passing large clots, bleeding for more than seven days, or feeling persistently tired and run down.

What is ‘problematic’?

Any irregular bleeding that occurs in between menstruation cycles, after sexual intercourse, or from no provocative factor, can cause problems or interfere with lifestyle. Persistent symptoms may need further investigations, such as scans or colposcopy or hysteroscopy. A clinic appointment is the initial step, with an examination if necessary and further steps can be discussed depending of patients personal views and choices.

Possible causes

Sometimes no structural cause is found, and the bleeding relates to the way the womb lining develops and sheds. In other cases there is an identifiable reason:

• Fibroids — benign growths in the muscle of the womb
• Polyps in the womb lining
• Adenomyosis, where womb lining tissue grows into the muscle wall
• Hormonal changes, particularly around the perimenopause
• Thyroid problems or bleeding disorders
• Rarely, pre-cancerous or cancerous changes in the womb lining

How it is assessed

Assessment usually begins with a conversation about your bleeding pattern and general health, followed by an examination. A blood test to check for anaemia is common.

An ultrasound scan gives a clear view of the womb and ovaries. Depending on what is found, a hysteroscopy — a thin camera examination of the inside of the womb, often done in the outpatient setting — or a biopsy of the womb lining may be recommended.

Treatment options

Treatment depends on the cause, whether you hope to become pregnant in future, and your own preferences. Options range from the simple to the surgical:

• Non-hormonal tablets taken during periods
• The hormonal coil, which is often very effective for heavy bleeding
• Other hormonal treatments, including the pill
• Modern non-hormonal treatment (GNRHa)
• Treatment of specific causes such as removal of polyps or fibroids
• Endometrial ablation, which treats the womb lining
• Hysterectomy, where other approaches have not worked or are not appropriate