Menorrhagia (Heavy Periods)

What is menorrhagia (heavy periods)

Most women will need to consult their doctor at some time for a problem relating to their periods. Periods are called ‘heavy’ if the total blood loss is greater than 60-80 ml (that's about half a cupful). It is impossible for women to know exactly how much blood they lose during their period. Therefore, the doctor will enquiry for certain symptoms, such as flooding, soaking of underwear or bedclothes and passing large clots of blood. He or she will also ask if heavy periods affect the quality of woman’s life such as going to work, doing sports or going shopping. Sometimes the only symptom of a heavy period problem is tiredness - this may be due to anaemia caused by the amount of iron lost with the blood. However, it is also true that some women have very heavy periods but their blood remains normal and hence they have no symptoms of anaemia.

What makes the periods heavy

In most women with heavy periods, the womb and ovaries are normal. The problem is likely to be due to local factors of the endometrium (lining of the womb):
• changes in the blood concentration of natural chemicals called     prostaglandins, which help to close off the blood vessels;
• changes in the blood clotting mechanism in the womb lining;

However other pathological causes have to be excluded before reaching this diagnosis. The doctor will check for specific problems such as:

• Fibroids
• Endometrial polyps
• Endometrial hyperplasia (thickening of the lining of the womb)
• Pelvic inflammatory disease (PID) due to infection;
• Underactive thyroid gland;
• Blood-clotting disorder
• Use of anti-clotting drugs (i.e warfarin)

Sometimes periods become heavier after certain phases or events in woman’s life. These are:
• After childbirth,
• After coming off the pill,
• Following the insertion of an intra-uterine contraceptive device  (coil).
•  During the years leading up to the menopause.

What is the treatment for menorrhagia

The treatment for heavy periods, as for any other medical condition, depends upon the cause and this is often difficult or impossible to determine.
Drugs will usually be tried first in an attempt to reduce the blood loss, along with iron tablets if the patient is anaemic. The doctor may then decide to try to help by providing drug treatment which involves taking one or other of two types of tablets - non-hormonal or hormonal drugs.

Non-hormonal drugs

Anti-prostaglandins (i.e Ponstan). These are taken just before and during the course of the period itself and act on the womb to reduce the flow of blood from its lining. They also provide effective pain relief if the periods are painful as well as heavy. These drugs can provide up to about a 25 per cent reduction in blood loss in about 75 per cent of women and are a useful first line of treatment.
Drugs which act by strengthening the small blood vessels in the womb lining (i.e.Tranexamic acid). These drugs are needed to be given only during the few days of woman’s periods and can considerably reduce the amount of blood loss.

Hormonal drugs

Oral contraceptive pill: can be very effective and may be appropriate if contraception is also required.
Progestogens (i.e, Provera, Duphaston): which can be taken for 1-3 weeks each month, and which can both reduce the blood loss to a certain extent and also regulate the periods if they are erratic.
Stronger hormones (LHRH analogues, danazol ) These are extremely effective drugs, but they may cause troublesome side-effects and should be avoided for long-term treatment.

Progesterone releasing device (MIRENA)

If drug therapy has not helped, and any other general disorders have been excluded, the progesterone releasing device (MIRENA) is the next reliable solution. This is a special coil which releases small amount of progesterone into the lining of the womb and unlike the standard coils, reduces the menstrual blood loss in 90% of women after one year.

Surgical Procedures

If all the medical treatment and the progesterone releasing device fail and woman no longer wish to have children an operation may be necessary. Possible operations are endometrial ablation, transcervical endometrial resection (TCRE) and hysterectomy.