Slow your flow

It’s safe to say that no woman enjoys that special time of the month, but some may dread it more than others, particularly if they experience heavy, hard-to-manage periods.

What is considered a heavy period?

The definition of a heavy period varies slightly from one woman to the next, according to Paulami Guha, MD, and Mary Ellen Wechter, MD, MPH, gynecologists with North Florida Gynecology Specialists who serve patients at Baptist Health. However, there are some common characteristics, including:

• Losing more than 80 milliliters of blood per cycle (the equivalent of a medium-sized perfume bottle).
• Lasting longer than seven days.
• Soaking one or more pads or tampons every hour (or leaking through into clothing or bedding).
• Passing clots of blood larger than a quarter.
• Having a negative impact on your quality of life.

What causes heavy menstrual bleeding?

The causes of a heavy period can vary greatly. Some include:

• Fibroids: Benign tumors of uterine muscle are the most common cause of heavy periods.
• Anovulation (not ovulating): Heavy, irregular bleeding occurs when the uterus doesn’t receive the correct signal to empty accumulated gland tissue each month. The resulting period is often heavy and prolonged (even for weeks!) or recurs weeks later. Common causes of anovulation are:
  • Inconsistent hormone signals from the brain during the first few years of adolescence or perimenopause (the years before stopping menses completely).
  • Thyroid disease.
  • Polycystic ovary syndrome (PCOS), a condition where the ovary makes too much male hormone (androgen), which prevents ovulation.
• Bleeding disorders (von Willebrand disease) or being on blood thinners.
• Cancer of the uterine lining (endometrium) or cervix, or sarcomas (cancer of the uterine wall).

“To help determine the cause of a heavy period, physicians need a thorough understanding of the patient’s medical history,” Dr. Guha said. “Additional tests include labs, a Pap smear to rule out precancer of the cervix, and imaging, such as an ultrasound or a pelvic MRI.”

Fibroids are the most common cause

The most common cause of regular heavy bleeding is fibroids, which impact about 70-80% of women by age 50, according to Dr. Wechter. Fibroids are benign tumors of uterine muscle that can cause bleeding when they form close to the lining (endometrium) of the uterus.

Dr. Guha said if a fibroid is located near where an egg may implant, it could lead to infertility, but the lesions themselves don’t cause inability to conceive. For that matter, neither does heavy bleeding.

However, paying attention to your body and its cycles is still important. For example, if you’re still bleeding after menopausal age, even if it’s light bleeding, you should be evaluated to ensure it’s not a sign of something more serious, like cancer.

Treatment options for heavy periods

The good news for those suffering from heavy periods is that there are many treatment options available.

“Life as a woman is hard enough without having to deal with the unnecessary burden of a heavy period,” Dr. Wechter said.

There are two main treatment categories:

Medicine

Birth control pills, intrauterine devices (IUDs) and devices that are implanted into the arm can be used to control heavy bleeding by increasing progesterone levels. Progesterone inhibits growth of the uterine lining and helps to keep the gland tissue more stable and less active/thick. This generally leads to lighter or absent periods.

While these hormonal options address the source of the bleeding, Dr. Wechter said tranexamic acid is another option to lessen bleeding without influencing hormones. It’s a prescription pill that slows the breakdown of blood clots in bleeding vessels to control very heavy or fast uterine bleeding.

Another class of drugs called GnRH antagonists can be used to alleviate heavy bleeding and resulting anemia, particularly when that bleeding is from fibroids. GnRH antagonists act on receptors in the brain to stop the hormone pulses to the ovaries, putting the body into a pseudo-menopausal state, allowing a woman to recover from anemia and prepare for a more long-term solution.

Surgery

Dr. Wechter said surgical options depend on whether the patient wants to have children after treatment.

For those who want to procreate, treatment involves fixing any existing structural problems that would make conception more difficult, such as removing a fibroid near the uterine cavity.

For women who don’t want children or feel their families are already complete, most hormonal treatments also prevent pregnancy temporarily, and for women who have exhausted medical treatments, a hysterectomy – removal of the uterus and fallopian tubes – may be an option. Most hysterectomies are now done as outpatient procedures with minimally invasive techniques, allowing much less discomfort, fewer complications, and a faster return to normal life.

“If your period is affecting your quality of life, don’t sit at home,” Dr. Guha said. “This is the 21st century; there are so many options available.”