Heavy menstrual bleeding (menorrhagia) is when periods are abnormally heavy or prolonged, interfering with daily life. It affects 1 in 5 women and can lead to fatigue, anaemia, or emotional distress.
Common Symptoms
- Soaking through a pad/tampon every 1–2 hours.
- Passing blood clots larger than a quarter.
- Periods lasting longer than 7 days.
- Fatigue or shortness of breath (signs of anaemia).
- Avoiding activities due to heavy flow.
Possible Causes
- Hormonal imbalances (e.g., thyroid disorders, PCOS).
- Uterine fibroids or polyps (non-cancerous growths).
- Bleeding disorders (e.g., von Willebrand disease).
- Medications (e.g., blood thinners, IUDs).
- Miscarriage or ectopic pregnancy (if sudden heavy bleeding).
- Endometriosis or adenomyosis.
Diagnosis:
- History: Track symptoms using a menstrual calendar.
- Tests:
- Blood tests (check for anaemia, thyroid issues, clotting disorders).
- Pelvic ultrasound (look for fibroids, polyps, adenomyosis or endometriosis).
- Biopsy (rule out endometrial cancer in high-risk patients).
Treatment Options
Medical Treatments
- Tranexamic acid: Reduces bleeding by 30–50% (taken during periods).
- NSAIDs (e.g., ibuprofen): Eases cramps and reduces flow.
- Hormonal therapies:
- Birth control pills, patches, or hormonal IUDs (e.g., Mirena®).
- Progesterone tablets to regulate cycles.
- Iron supplements: For anaemia.
Surgical Options
- Endometrial ablation: Thins the uterine lining (not for future pregnancy).
- Myomectomy: Removes fibroids.
- Hysterectomy: Removes the uterus (last resort for severe cases).
Frequently Asked Questions
Q: Is heavy bleeding normal?
A: No—seek evaluation if you’re changing pads/tampons hourly or passing large clots.
Q: Can this affect fertility?
A: Depending on the cause (e.g., fibroids), yes. Early treatment improves outcomes.
Q: Do I need treatment if I’m not anaemic?
A: Yes! Heavy bleeding impacts quality of life, even without anaemia.
Q: Is this linked to menopause?
A: Heavy bleeding near menopause may signal hormonal changes or other conditions.
Q: How can I stop the bleeding now?
A: Tranexamic acid or NSAIDs can reduce flow quickly. Ask your doctor.
eGynaecologist Advice:
- You must seek urgent gynaecological care if bleeding soaks through 2 pads/hour for 2+ hours or if you feel dizzy, faint, or have chest pain.
- Heavy periods are common but treatable, and you should consult your gynaecologist if heavy bleeding disrupts work, school, or social life.
- You must consult gynaecologist if bleeding continues after menopause as this may indicate endometrial cancer (1 in 10 women with post-menopausal bleeding)
