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Heavy Menstrual Bleeding

What is heavy menstrual bleeding?

During a normal period a woman usually loses between 30ml and 40 ml of blood.  When periods are heavier than what would normally be expected, or the amount of bleeding india.jpgterferes with the woman’s social, physical or emotional quality of life then this can be considered heavy menstrual bleeding. 

How common is heavy menstrual bleeding?

Heavy menstrual bleeding is a common problem in women affecting approximately one quarter of women at some stage, although not all women seek treatment for it. 

What causes heavy menstrual bleeding?

There are a number of factors that may contribute to heavy menstrual bleeding, although in the majority of cases no obvious cause will be found.

Hormones

An imbalance in hormones might lead to irregular periods which can affect the lining of the uterus and result in heavy bleeding.  Common conditions which might lead to a hormone imbalance include polycystic ovarian syndrome, peri-menopause (the time leading up to the menopause) or thyroid problems.

Uterine related problems

  • Fibroids –non-cancerous growths of muscle in the uterus which can lead to heavy periods (see Fibroids brochure).
  • Uterine polyps – an overgrowth of the lining of the womb can lead to a thickened fold of tissue inside the womb.
  • Adenomyosis is a condition where the lining of the womb tissue may grow into the wall of the uterus (normally containing muscle).
  • Cancer or precancerous changes in the lining of the womb. This is a rare cause for heavy menstrual bleeding, but women may be at increased risk of this if they:
    • are over the age of 45
    • are over 90kg in weight
    • have never had children
    • have a family history of cancer of the uterus, ovary or bowel
    • have polycystic ovarian syndrome
    • carry a gene that increases their cancer risk.

Blood related disorders

Blood disorders that lead to a higher risk of bleeding in general, or women who are on blood thinning medications are also more likely to experience heavy menstrual bleeding.

What are the problems related to heavy menstrual bleeding?

Heavy menstrual bleeding can have a significant impact on a woman’s ability to attend to her daily activities, including impacting work, family duties and personal relationships and includes the cost of sanitary protection.  Heavy menstrual bleeding can also result in low iron levels or anaemia causing tiredness or fatigue.

How is heavy menstrual bleeding diagnosed?

There are no specific diagnostic criteria for heavy menstrual bleeding, but your doctor may order tests to check for the cause of the heavy menstrual bleeding, and to assess for complications such as low iron levels or anaemia.

What tests might be required?

The exact tests you have will depend on your circumstances but may include:

  • a pelvic examination and cervical screening (pap) test, and possibly swabs to check for infection
  • blood tests to check your hormones,  including your thyroid, and to check for iron levels,  anaemia, or bleeding disorders
  • an ultrasound of your uterus and ovaries— preferably done through the vagina to assess for fibroids, polyps or thickening of the lining of the womb
  • an endometrial biopsy (sample of the lining of the womb) which may be required to determine if there are any pre-cancerous or cancerous changes—this can usually be performed in the clinic
  • a hysteroscopy to look inside the womb and take a biopsy at the same time (problems such as polyps or fibroids may be able to be treated at the same time). (see Hysteroscopy brochure)

What are the treatment options?

There are a range of treatment options available for heavy menstrual bleeding. The most appropriate treatment will depend upon the cause of the heavy menstrual bleeding and the woman’s desire for fertility. Some women prefer to have no treatment; as long as they are reassured there is nothing cancerous causing the heavy menstrual bleeding.

Medical treatments (non-hormonal)

These are appropriate for women who wish to remain fertile or not take hormonal medications.

  • Iron tablets—may prevent or treat anaemia but don’t affect the heaviness of the bleeding.
  • Tranexamic Acid—helps blood to clot and can reduce the amount of blood lost.
  • Non-steroidal anti-inflammatory medications— can help to reduce the amount of blood lost and can also reduce menstrual pains (tablets like ibuprofen, ponstan etc).

Medical treatments (hormonal)

These treatments may not be appropriate for women who wish to fall pregnant, but fertility will return after treatment is stopped. 

  • Oral contraceptive pill— can regulate the timing of periods and reduce the amount of blood lost and will prevent pregnancy.
  • Depo- provera—3 monthly injections can reduce the amount of bleeding and eventually lead to no periods at all and will prevent pregnancy.
  • GnRH Analogues— induce a menopausal state to temporarily halt the periods, but shouldn’t be used long term.

Mirena intra uterine device

A small device that secretes a low dose of hormones to reduce the amount of blood loss (see Mirena brochure )

Uterine artery embolization

A procedure done by X-ray that can shrink fibroids to reduce the amount of fibroid related bleeding (see Fibroid brochure for information about uterine artery embolisation)

Surgical treatments

If non-surgical treatment options do not provide sufficient relief from symptoms, an operation may be required. There are various surgical procedures and approaches to treat heavy menstrual bleeding, which may depend on the cause of the bleeding. They include:

  • a hysteroscopy  to remove a fibroid or polyp (see Hysteroscopy brochure)
  • an endometrial ablation  burns the lining of the womb so it does not build up and shed each month— only for women who have completed their family or don’t wish for children (see Endometrial ablation brochure)
  • a myomectomy removes a fibroid/s and is performed by a cut in the abdomen or keyhole surgery

How do I know what the best treatment for me is?

Your doctor will help you to decide what the most appropriate treatment for you is.  Your decision making will be guided by:

  • the cause of the heavy menstrual bleeding
  • any desire for a pregnancy, either currently or in the future
  • treatments that have been tried in the past
  • other medical concerns you may have
Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: PI-CLN-430201
Last modified 10/7/2018.
Consumers were consulted in the development of this patient information.
Last consumer engagement date: 25/6/2018
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