Family Planning - Management Of Heavy Periods

Heavy Menstrual Bleeding

1 in 3 women describe their periods as heavy. However, it is often difficult to know if your periods are normal or heavy compared with other women. Some women who feel they have heavy periods actually have an average blood loss. Some women who feel they have normal periods actually have a heavy blood loss. Most of the blood loss (about 90%) usually occurs in the first three days with either normal or heavy periods.

A normal period is a blood loss between 20 and 60 ml (4-12 teaspoonfuls). Bleeding can last up to eight days, but bleeding for five days is average.
A heavy period is a blood loss of 60-80 ml or more. This is about half a teacupful or more. However, it is difficult to measure the amount of blood that you lose during a period. For practical purposes, a period is probably heavy if it causes one or more of the following:

  • Flooding through to clothes or bedding.
  • You need frequent changes of sanitary towels or tampons.
  • You need double sanitary protection (tampons and towels).
  • You pass large blood clots.

 

This may be a problem that you have always had or you may find that your periods get heavier as you get older.

There is not normally a cause of heavy periods and 4-6 out of 10 women have heavy periods with no underlying cause found.  This is called dysfunctional uterine bleeding.

There is sometime a reason for heavy periods and the commonest reason is due to fibroids.  These are non cancerous growths in the muscle of the uterus (womb) which may have no symptoms at all but can cause your period to be heavier.

If you have heavy periods but are able to manage them you may feel that you do not need to see a doctor.

However if you find your periods are heavy and are unmanageable or affecting your quality of life and what you can do at the time of your period there are several treatment options available to you and it may be a good idea to book an appointment to discuss possible treatment options with your GP.

It is always helpful to keep a menstrual diary for 3 months to help keep track of your period and how it might be changing.  Please bring this information to the GP appointment.

It is likely the doctor will ask to examine you and may suggest swabs and a smear test if this is due.  They may also suggest a blood test to check for anaemia but this is not always necessary.

 

Treatment Options:

 

  • Levonorgestrel IUS - The most effective treatment for heavy periods is the IUS (levonorgestrel interuterine system or mirena coil).  This is endorsed by NICE (National Institute for Care Excellence).  This is a hormonal coil which can be fitted in women with heavy periods and in 70% of women, within 6 months of having it fitted, their periods will stop completely or become significantly lighter.  It can also be fitted for up to 5 years for contraception (please see contraception pages on this website).  It is extremely reliable and most women are very pleased with the effect it has on their periods.  It can be easily removed if the woman is not happy with it for any reason.

 

  • Tranexamic acid - this is a tablet that can be taken to reduce menstrual flow if the IUS is not suitable or declined.  It can reduce flow up up to 40 % but has no effect on duration of period or period pain.  The tablets need to be taken 3 times a day for 3-5 days of your period.

 

  • Combined contraceptive pill - this is an option for some women.  The COC as well as working for contraception also causes most women to have a lighter period.  This is not suitable for all women but can be discussed with the GP.

 

  • Norethistrone - this is a hormonal medication which can stop prolonged, heavy bleeding.  It is not normally used in the long term for women with heavy periods.  It can also cause bloating, fluid retention and breast tenderness.

 

  • Surgery - In some cases the methods above are not successful and surgery is considered.  This will be discussed with you by your GP.

 

We hope you have found this overview helpful and ask that is you have any concerns about your periods you book a routine appointment with your GP.