Heavy uterine bleeding (previously known as menorrhagia) is excessive menstrual bleeding. The amount of menstrual blood varies from woman to woman and can change at different stages in your life, e.g. approaching menopause. Heavy uterine bleeding is a common problem in the 30-50 year old age group and may have a serious impact on your health and daily life. (Note: postmenopausal women should not be bleeding/spotting. See your health practitioner for advice.)
It can be difficult to diagnose heavy uterine bleeding – what one woman considers heavy, another may consider normal. The best guide is to decide whether your period is impacting on your quality of life e.g. causing you to be housebound, interrupting your daily activities, or causing you stress and anxiety. In addition, the following signs may indicate that you are experiencing heavy bleeding:
- Unusual increase in blood loss
- More than seven days of bleeding
- Bleeding or flooding not contained within pads or tampons (especially if wearing the largest size)
- Clots greater than a 50 cent piece in size
- Dizziness, fatigue or looking pale during your period
- Needing to change pads/tampons within 2 hours and using thicker or larger pads/tampons
- Waking up at night several times to change pads/tampons
Complications associated with heavy bleeding include:
- Fatigue, dizziness or pale appearance
- Low iron levels because of the blood loss
- Cramping and pain in the lower abdomen
- The inconvenience of having to change sanitary products frequently and the fear of bleeding through to your clothes may affect your daily activities
It is important to investigate the cause of your heavy bleeding – you don’t have to put up with it.
Possible causes include gynaecological conditions such as endometrial polyps, endometrial hyperplasia (thickening of endometrial lining), fibroids, adenomyosis, endometrial cancer, and intrauterine devices (IUDs). Other causes include chronic kidney disease, blood disorders e.g. von Willebrand’s disease, and hormonal conditions such as hypothyroidism. (For more information visit www.healthforwomen.org.au ) In about half of cases, no cause can be identified.
Your health practitioner may recommend iron therapy if your iron levels are low. This is usually a tablet that is taken daily. You may also be prescribed other treatments such as:
- Certain anti-inflammatory drugs to reduce bleeding and period pain, such as ibuprofen, mefenamic acid and naproxen sodium
- Tranexamic acid to reduce the bleeding
- An IUD, releasing a hormone which thins the endometrium and reduces bleeding up to 95 per cent after 12 months of use, e.g. Mirena
- The contraceptive pill to reduce period pain and provide contraception (blood flow can be reduced by up to 50 per cent by using the pill)
- Progestins (synthetic forms of progesterone, one of the female hormones) to reduce blood loss by about 30 per cent
In some situations, surgery such as endometrial ablation (burning of the lining of the uterus) or hysterectomy may be appropriate. This should be discussed with your health practitioner.
September 10 is International Gynae Awareness Day. For more information, visit www.gain.org.au or www.healthforwomen.org.au/sexual-health/gynaecological-awareness
Published with the permission of the Jean Hailes Foundation for Women’s Health.
Visit www.jeanhailes.org.au or call tollfree 1800 JEAN HAILES (532 642) for further health information.
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