From the Guidelines
Heavy periods are medically known as menorrhagia, a condition characterized by abnormally heavy or prolonged menstrual bleeding that interferes with a woman's physical, social, and emotional quality of life. Typically, menorrhagia involves bleeding that lasts more than 7 days or blood loss exceeding 80 milliliters per cycle. Women with this condition may need to change their pads or tampons every hour for several consecutive hours, pass large blood clots, or experience bleeding that disrupts daily activities. Menorrhagia can result from various causes including hormonal imbalances, uterine fibroids, polyps, adenomyosis, certain medications, or underlying medical conditions like thyroid disorders or blood clotting problems.
According to the most recent guidelines, treatment options depend on the cause and may include hormonal medications like birth control pills, tranexamic acid (Lysteda), nonsteroidal anti-inflammatory drugs (NSAIDs), or in some cases, surgical interventions 1. The American College of Radiology suggests that endometrial ablation is a minimally invasive technique that can be performed for patients with uterine fibroids associated with heavy menstrual bleeding who are refractory or intolerant to medical therapy 1. However, this procedure is only indicated in patients who do not desire future pregnancy.
Some key points to consider when diagnosing and treating menorrhagia include:
- Identifying the underlying cause of the heavy bleeding
- Assessing the impact of the bleeding on the woman's quality of life
- Considering the woman's desire for future fertility
- Evaluating the risks and benefits of different treatment options, including medical and surgical interventions 1. It is essential to consult a healthcare provider for proper diagnosis and treatment, especially if the bleeding causes anemia or significantly impacts daily life.
From the Research
Definition of Heavy Periods
- Heavy periods are also known as menorrhagia, which is defined as menstrual periods lasting more than 7 days and/or involving blood loss greater than 80ml 2.
- Menorrhagia is a common problem that can limit normal activities and cause anemia in two-thirds of women with objective menorrhagia (loss of 80 mL blood per cycle) 3.
- Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss (MBL) >80 mL per cycle, that interferes with a woman's physical, emotional, social wellbeing and quality of life 4.
Causes and Diagnosis
- The causes of heavy periods can be due to underlying uterine pathologies, coagulopathy, ovulation dysfunction, or iatrogenic factors 4.
- Assessment of HMB should entail a menstrual and gynaecological history and a bleeding score to distinguish those women who require additional haematological investigations 4.
- A pelvic examination and ultrasound scan can help to rule out the presence of any underlying pathology 4.
Treatment Options
- Medical therapies for heavy periods include hormonal treatments, such as levonorgestrel-releasing intrauterine system (LNG-IUS) and combined hormonal contraceptives 4, 5, 6.
- Haemostatic therapies, such as tranexamic acid and DDAVP (1-deamino-8-D-arginine), can also be used to reduce menstrual blood loss 4.
- Surgical options, such as endometrial ablation and hysterectomy, may be considered in severe cases or when medical therapies have failed 4, 2, 3.