Heavy periods are very common in women, and usually are not a sign of anything serious – but they can cause a big disruption on to your life. Heavy periods can cause fatigue from low blood count.  Periods that become heavier or irregular as you are coming to menopause is not normal. Bleeding in between periods or after intercourse is abnormal and needs investigation

Causes
In most cases there is no cause found for heavy bleeding. The uterus and ovaries are normal and the female hormones are normal. Occasionally there is a cause for heavy bleeding and this can include:

  • Fibroids
  • Endometrial polyps
  • Other abnormalities
  • of the lining of the uterus (endometrium)
  • Hormonal problems

Your doctor may want to do an internal (vaginal) examination to examine the cervix and to assess the size and shape of your womb. If the internal examination is normal and you are under the age of 40, no further tests are usually needed.

Further tests may be advised for some women

  • Additional blood tests – If you doctor suspects you have an underactive thyroid gland or a bleeding disorder then more blood tests may be requested.
  • An ultrasound scan of your uterus – The ultrasound scan can usually detect any fibroids, polyps, or other changes in the structure of your uterus.
  • Internal swabs – Your doctor may wish to take some swabs from inside the vagina if infection is the suspected cause of the heavy bleeding.
  • Pipelle – (Endometrial sampling): This is where a very thin sampling probe is passed into the uterus through the cervix to obtain any sample of the uterine lining (endometrium).
  • Hysteroscopy D&C – This is where a doctor can look inside the uterus by inserting a thin mini telescope into the uterus via the vagina. A sample of the lining of the uterus will be taken if needed and sent away to the laboratory for testing.

Hysteroscopy is able to detect fibroids, polyps, or an abnormal thickened lining; polyps and small fibroids may also be removed from inside the uterus during this procedure. The tissue that is removed is also sent to the laboratory for examination.

Medical Therapy
Tranexamic Acid – this is a non-hormonal form of treatment and is taken as a tablet – typically 3-4 times a day, for 3-5 days during your period. It is used to stop or reduce heavy bleeding and can reduce the heaviness of bleeding by up to half in some women.

Tranexamic acid decreases the heaviness of bleeding by reducing the breakdown of blood clots in the uterus. The body typically forms blood clots to stop bleeding and in some women, these blood clots break down causing too much bleeding.

Non-steroidal ant inflammatory (NSAID) – this medication is taken as a tablet typically for a few days during each period. The more commonly available forms of this are ibuprofen or nurofen, which can be purchased from your local pharmacy; however other types are available that your doctor may prescribe for you.

This form of medication works by reducing the high level of prostaglandin (hormone) in the lining of the uterus. Prostaglandins seem to contribute to heavy periods and period pain and this medication also eases period pain as well as reducing the heaviness of bleeding however they do not reduce the number of days the period lasts.

Combined Oral Contraceptives – is a hormonal form of treatment and is taken as a tablet (pill), one per day. The pill contains the hormones progestogen and oestrogen and is normally used to prevent pregnancy. It is the lining of the uterus that comes away every month in the form of the period; a thinner lining can result in reducing the heaviness of the bleeding.

Oral Progestogen – if you have prolonged bleeding your doctor might start you on oral progestogen (Norethisterone or Provera).
Mirena (Intrauterine Contraceptive Device – IUCD) – Mirena is a type of IUCD which is a small device that sits inside the womb (uterus). Mirena slowly releases a small amount of the hormone progestogen. Mirena reduces period bleeding and pain so most women will have light bleeding or no periods at all. It is a long-acting treatment, with each device lasting five years, although it can be taken out at any me.

The Mirena is typically used as a contraceptive device. It primarily works by thickening the mucus plug, preventing sperm entering the womb and also prevents the egg from implanting in the uterus. The Mirena also makes the lining of the uterus very thin.

Surgical Treatment
Endometrial Ablation – this is the where the lining of the uterus (endometrium) is destroyed.  In some women, bleeding does not stop but is reduced to normal or lighter bleeding. If this procedure does not control the bleeding, further treatment or surgery may be required. Endometrial ablation is only performed in women who no longer wish to have children.

Polypectomy and Fibroid Resection – if polyps or broids (located within the uterine cavity) are found, a special instrument is passed through the hysteroscope to remove them.

Myomectomy – this is a procedure whereby fibroids are removed but the uterus is saved, especially where fertility is desired. This can be done by hysteroscopy, laparoscopy (key-hole surgery) or laparotomy (cut in abdomen). The type of surgery depends on the position and size of the fibroids. Laparoscopy and laparotomy forms of myomectomy are done under general anaesthetic.

Hysterectomy – Hysterectomy is the surgical removal of the entire uterus and thus periods stop permanently.
There are 3 types of hysterectomy and all are done under general anaesthetic:

  • Abdominal hysterectomy – your uterus, cervix, fallopian tubes and ovaries will be removed via an incision in your abdomen.
  • Vaginal hysterectomy – your uterus, cervix will be removed via an internal incision at the top of the vagina. You will be given the op on to have your fallopian tubes and ovaries removed at the same me.
  • Laparoscopic hysterectomy – your uterus is removed via laparoscopic procedure. A small cut of about one-centimeter-long is made in the belly button so that the laparoscope (telescope) can be inserted into the abdomen. Other small cuts are made which allow different instruments to be introduced into the abdomen so that the uterus can be removed.