No woman enjoys her period – it’s generally a bothersome and often painful time. But for women suffering from menorrhagia, period time presents a more serious issue. Menorrhagia is the medical term for excessive or prolonged menstrual bleeding, and can affect menstruating women of all ages. Women with menorrhagia lose about 5 to 6 tablespoons of blood each period – around double the amount lost in a normal period.
Losing a lot of blood during menstruation can cause lifestyle issues and medical problems such as painful cramps and iron deficiency anaemia (lower than normal amounts of red blood cells).
There are a number of reasons why a woman may be experiencing menorrhagia. These include:
Anovulation occurs when a woman’s ovaries fail to release an egg (ovulate). Since the normal hormonal changes of ovulation do not occur, the lining of the uterus does not shed and regrow as in a normal menstrual cycle, but continues to grow thicker until it sheds irregularly, resulting in heavy and/or prolonged bleeding. Anovulation is usually the cause for adolescent menorrhagia, and it is also common before menopause and with some disorders, such as hypothyroidism and polycystic ovary syndrome.
- Bleeding tendency
Menorrhagia can result from conditions that prevent the blood from clotting normally. Some examples are von Willebrand disease, low platelet count or platelet dysfunction, and use of anticoagulants (blood thinners).
- Uterine growths
When adult women experience menorrhagia, it may be due to a benign growth in the uterus. The most common growths include polyps, fibroids, adenomyosis and, rarely, cancer.
In women with menorrhagia due to bleeding issues or uterine growths, the lead up to the menstrual period will usually be normal, but bleeding is excessive. In women with menorrhagia due to anovulation, their entire cycle will usually be abnormal and irregular.
Signs and symptoms
Women with menorrhagia typically experience one or more of the following:
- Need to change pads/tampons more frequently than every three hours
- Need to use both pads and tampons to absorb menstrual flow
- Need to change pads or tampons during the night to absorb menstrual flow
- Pass blood clots larger than 2cm
- Iron-deficiency anaemia
If your doctor suspects menorrhagia based on the description of your bleeding, he or she will try to determine the cause by performing a medical history and physical examination.
You might also be recommended an endometrial biopsy, in which a small sample of the uterine lining is removed. This may be performed in the office or in day surgery.
Laboratory tests may be recommended to look for bleeding disorders or thyroid disease. In some cases, the provider may recommend imaging tests, most commonly a pelvic ultrasound, to look for endometrial polyps, fibroids, or adenomyosis.
The treatment of menorrhagia depends upon the cause and severity of the condition, the patient’s preferences, any need for contraception, and the woman’s desire to have children in the future. Some common medical treatments are listed below. If one or more of these treatments are not successful, a surgical treatment may be recommended.
- Combined oral contraceptives
Use of combined (oestrogen and progesterone) oral contraceptives decreases menstrual blood loss over time. The pills can also be taken continuously so that a woman may skip her period if she chooses, for as long as desired. This is a particularly good treatment for women with painful periods. Some women may experience breakthrough bleeding, but does not mean that there is an increased risk of pregnancy (unless pills are forgotten). Alternatively, a vaginal ring may be used instead of pills.
Progesterone is a hormone made by the ovary that is effective in preventing excessive bleeding in women with chronic anovulation. A synthetic form of progesterone, called progestin, can be given as a pill, injection, implant under the skin, or an intrauterine contraceptive known as Mirena. Mirena is the most effective medical treatment for menorrhagia, is relatively inexpensive, and helps at least 60 percent of women to avoid surgery. Progestin pills do not prevent pregnancy while the injection and Mirena are contraceptive.
- Anti-inflammatory medications
Anti-inflammatory medications, such as ibuprofen and mefenamic acid, can help relieve the pain of menstrual cramping and reduce blood flow. They are relatively inexpensive, have few side effects, and only need to be taken for three to five days during the menstrual period. However, some women find that they cause stomach upset.
- Antifibrinolytic agents
Drugs like tranexamic acid only need to be taken on the days of bleeding, do not interfere with fertility, and, since they act within two to three hours of administration, can also be used for acute control of bleeding. However, some women experience side effects, such as stomach problems, leg cramps, dizziness, and headaches.
- Gynaecological surgery
For women who have known abnormalities of the uterus, such as polyps or fibroids, surgical removal of these lesions may cure the menorrhagia. Some fibroids may also be treated by cutting off their blood supply.
If you’re experiencing abnormal, particularly painful or heavy periods, it’s a good idea to have a discussion with your GP who can refer you to a gynaecologist for treatment. All of Eve Health’s gynaecologists have skills and experience in managing menorrhagia.