Monthly Misery

Philippa Moth, Consultant Gynaecologist at the Spire Tunbridge Wells Hospital, answers questions about a common problem that many women suffer from.

What is the definition of heavy periods?

Known as menorrhagia, this is where a woman loses an excessive amount of blood during each period.

How much is heavy bleeding?

The medical definition is loss of 80ml or more of blood during each period, but this is very difficult and not practical to measure.

You may be losing excessive blood if:

• You are using more tampons and sanitary towels than usual
• You need to get up in the night to change tampons and sanitary towels
• You experience flooding
• You are unable to leave your home when you have a period

What causes heavy periods?

In the majority of cases no cause for the heavy bleeding can be identified. This is called dysfunctional uterine bleeding.

The following can cause heavy bleeding:

• Fibroids
• Polyps
• Abnormal cells within the lining of the womb such as hyperplasia (a benign overgrowth of the lining) or cancer
• Coagulation disorders
• Medical disorders such as thyroid disease

How are heavy periods investigated?

An ultrasound scan of the womb can often identify fibroids and polyps and can also provide information on the thickness of the lining of the womb.

In some cases we may recommend looking directly into the womb with a camera (hysteroscope). A biopsy from the lining of the womb can be taken at the same time.

Treatment of Heavy Periods

There are lots of different treatments for heavy periods and our recommendation for treatment will vary according to your symptoms and the results of the investigations.

If a specific cause is identified such as a fibroid or a polyp then we may recommend its removal. It is often possible to do this under a short general anaesthetic as a day case procedure.

Medical treatments of heavy periods

• Tranexamic acid, norethisterone and the contraceptive pill can all be used to lighten period flow and are often used in the first instance by general practitioners to help with excessive bleeding.
• The Mirena coil is a coil designed specifically for women with heavy periods. This coil releases a progesterone hormone into the womb which thins the lining and either lightens or ceases periods.

Surgical treatments of heavy periods

• Endometrial ablation. This is a procedure that is used to remove (ablate) or destroy the lining of the womb and is usually done as a day case procedure under a short general anaesthetic.
• Hysterectomy (removal of the womb). Some women may choose to have their womb removed because other treatments have failed or we may recommend this option due to a specific abnormality. We always aim do this operation by key hole surgery (laparoscopically) and patients usually stay in for one night in hospital.

How to book an appointment

Miss Philippa Moth holds weekly clinics at the Spire Tunbridge Wells Hospital. If you would like to self-refer for any concerns you have she is very happy to see you. For more information or to book an appointment then please call their Customer Services Executive on 01892 741150.