Heavy periods

It can be difficult to determine if you are suffering from Heavy Menstrual Bleeding, as “heavy” to one woman may be “normal” or even “light” to another.

Most women lose between 30ml – 80ml of blood during a single period. A greater volume loss or a period that lasts longer than 7 days can be considered heavy and/or prolonged.

Usually, the actual volume of loss is not measured but the following symptoms are used by doctors to judge the heaviness of periods:

• “Flooding” – this means bleeding through your clothes during the day or on to your bedding whilst you sleep, despite using sanitary products
• Frequent changes of your sanitary products – having to change products every hour or two during the day
• If you are passing large blood clots – larger than the size of a 10p piece
• If your periods are stopping or restricting you from your daily life
• If you are wearing “double sanitary protection” – for example having to wear both a sanitary towel and a tampon

For more information on signs and symptoms of heavy bleeding, and further advice on when to see your GP, please visit the NHS website.

Seeing your GP

You may decide to make an appointment with your GP if you are experiencing heavy bleeding or bleeding that is disrupting your health, lifestyle and wellbeing.

If you do decide to make an appointment with your doctor, they will normally ask you about your bleeding and how this is affecting you.

You should also visit your doctor if you are experiencing other symptoms, such as bleeding after sex (postcoital bleeding) or bleeding between your expected periods (intermenstrual bleeding).

WearWhiteAgain.co.uk have developed a period diary, which you may wish to fill out prior to your appointment to keep track of your bleeding.

For women who may feel anxious about discussing their bleeding with their doctor, taking evidence such as this may help you to feel more relaxed at your consultation.

During your appointment, your GP may also ask you questions to see if you are experiencing any other symptoms alongside your bleeding, and may consider offering you a blood test. Your doctor may also suggest an internal examination or further diagnostic tests such as an ultrasound scan.

Most cases of heavy menstrual bleeding can be managed by your GP, but in certain circumstances your GP may suggest a gynaecological referral.

Treatment Options

There are several treatment options for heavy periods. The treatment that your doctor suggests to you depends on several factors, such as the likely cause, your overall health and your own preferences. Certain treatments are not suitable for everyone, so a treatment plan can only be made after a thorough consultation with your GP or specialist.

The treatments that may be offered to you initially include:

• Insertion of an IUS (Intrauterine System) device – this small device is inserted into the womb by a healthcare professional. The device contains a hormone called progestogen which is slowly released into the lining of the womb and has been shown to reduce menstrual bleeding by up to 90% after one year.
• Hormonal medication such as the combined pill or an injectable progestogen
• Non-hormonal medication such as NSAIDs or Tranexamic acid

What will happen if I do not receive treatment?

The decision not to treat heavy periods is an option for some women, particularly if there is no obvious cause for your bleeding and it is not affecting your everyday life.

Is there anything I can do to help my Heavy Menstrual Bleeding?

It is advisable for women who have Heavy Menstrual Bleeding to keep a balanced, healthy diet which is low in fat and includes a variety of high-iron foods, such as red meat, spinach and breakfast cereal with added iron.

Weight loss may be recommended as there is a link between being overweight and heavier periods.

Other lifestyle advice should be taken, such as taking regular exercise, quitting smoking if you are a smoker, or staying within recommended guidelines for alcohol consumption.

In a small number of cases, surgery may be considered. However, there are always risks associated with surgery and it involves time consuming hospital visits as well as time recovering from surgery. Less invasive non-surgical options are effective for most women. For these reasons, women are usually expected to try non-surgical options before any referral for possible surgery. Endometrial ablation, surgical management of fibroids and hysterectomy are all options, but hysterectomy is viewed as a last resort and the other options should have been tried first. Hysterectomy rates have dramatically reduced since the introduction of the IUS which is extremely effective in most cases.

• Read more about treatments for heavy menstrual bleeding on the NHS website

Local commissioning policies have been put in place for surgical management to ensure women in Devon receive the most effective and safe treatment.

• Read more about the policy for surgical management of Heavy Menstrual Bleeding
• Read more about the policy for Dilation and curettage for Heavy Menstrual Bleeding

You can find more information about Heavy Menstrual Bleeding from the following resources:

• Patient.info – About heavy periods
• The NHS Website – Heavy periods condition page
• Wearwhite again – Support and information

Wearwhiteagain – Dr Anne Connolly discusses Heavy Menstrual Bleeding
Wearwhiteagain | Published 9 October 2018

Patient – When is a period too heavy?
Patient | Published 12 September 2018