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Mr Radwan Faraj, Consultant Obstetrician & Gynaecologist
Claremont Clinics: Monday EVE
Every woman’s periods are different and what is heavy for you may not be for another woman. Heavy periods are not usually a sign of anything serious but they can disrupt your life and make you feel miserable. The good news is, there are several medicines that work well and if they don't help, surgery could be an option.
Do you find heavy periods a problem?
You may find it hard to judge whether your periods are heavy and even talking to friends about it may not help. Women often have different ideas about what it means to have heavy periods.
Here's a list of things that may mean your periods are heavy.
· You use more than 8-9 pads or tampons (or both pads and tampons) on your heaviest days.
· You have to wear both a tampon and a pad (double protection).
· Your period lasts more than 6 days.
· You have to get up at night to change your protection.
· You pass large clots of blood.
· You stain your bedding or clothes despite wearing tampons and pads.
· You stay at home during your period because you are worried about having an 'accident'.
· You feel tired, especially during your period. This could mean your body is low on iron, we call this anaemia. It happens when your body is not able to make enough new red blood cells to make up for blood lost during your period. Your doctor can find out if you have anaemia by performing a simple blood test. If your red cell count is low, you may need treatment such as iron tablets, to help you make more red cells. If your periods are heavy for more than a few months and they're making your life miserable, you may want to get help from your doctor.
How is the diagnosis made?
Blood tests: You may have a simple blood test to check you have enough iron in your blood.
Ultrasound scan: If your doctor thinks you may have fibroids (non-cancerous growths in your womb), a Pipelle endometrial sample from the lining of the womb (endometrium) may be obtained to check for abnormalities. This can be done during a vaginal (internal) examination at an outpatient appointment, using a very fine plastic tube, which is passed through the neck of the womb (cervix).
Hysteroscopy is a look inside the womb with a small telescope and camera at which time a sample of the lining of the womb is obtained to make sure there is no abnormality within the cells. Common abnormalities such as polyps or fibroids can be detected and be removed at the same time. If you bleed after sex or have pain or bleeding between, it’s important to go to your doctor as sometimes these can be symptoms of more serious conditions.
What treatments work?
There are several treatments for heavy periods including contraceptives. You should decide with your doctor which one might suit you best and if the first treatment you try doesn’t help, your doctor should be able to offer you something else.
Theses treatment are usually prescribed by your GP and if they fail, referral to a specialist is important to consider surgical options.
· Tranexamic acid is one of the best drug treatments for heavy periods. About 6 out of 10 women who take tranexamic acid get lighter periods. Research found that women taking this drug had a better social and sex life, because their periods were lighter. There are some side effects, about one third of women who take tranexamic acid feel queasy and get leg cramps.
· Nonsteroidal anti-inflammatory drugs (NSAIDs) may be a better option if your periods are painful as well as heavy. Mefenamic acid (brand name Ponstan) is the NSAID most often used to treat heavy periods. Other NSAIDs include Diclofenac (Voltarol) and Naproxen (Naprosyn). People who have heart problems should not take Diclofenac. About half the women who take NSAIDs say their periods become lighter and about 7 in 10 say NSAIDs help with period pain.
· Mirena Intrauterine System (IUS). You may want to consider having a coil fitted that gradually releases the hormone progestogen into your womb. You may have heard this called an IUD (intrauterine device) and it is also a contraceptive, so you won’t be able to get pregnant if you have one fitted. It reduces bleeding for most women and for some, this coil stops their periods completely after about 12 months. You may bleed slightly more during the first few months after you have this coil fitted and in between periods. You may also feel boated and have tender breasts.
· The combined contraceptive pill contains the hormones oestrogen and progestogen. It may make your periods lighter as much as NSAIDs do but you may get some mild side effects such as queasiness, headaches, tenderness in your breasts and changes in your weight.
· Progestogen tablets aren’t normally used for heavy periods but they may be prescribed if you’re having a very heavy or long period, or to prevent bleeding. Progestogen is the hormone contained in the progestogen-only pill (also called the mini-pill) which is used as a contraceptive. If your periods are heavy, a mini-pill might not be the best choice as it can make periods heavier. Progestogen tablets can cause headaches, breast tenderness, stomach upsets, tiredness and bloating.
Surgical treatments for Heavy periods
We will probably recommend surgery for heavy periods if drug treatments haven’t helped you.
Endometrial Ablation: An operation to remove/destroy just the lining of your womb can make your periods lighter and some women's periods stop altogether. The operation is performed through the vagina and is only suitable for women who do not desire more children, you should carry on using contraceptives.
Removal of Fibroids (Myomectomy): If you have fibroids, an operation to remove them (called a myomectomy) might make your periods lighter and this operation can be done through a cut in the abdomen, vaginally or using keyhole surgery.
Hysterectomy for heavy periods: Having an operation to remove your womb (a hysterectomy) is the only way to be sure that your periods stop completely. You can’t have children after this operation and you can also have your ovaries and fallopian tubes removed at the same time. If your ovaries are removed, you’ll experience symptoms of the menopause afterwards and you may need to take hormone replacement therapy (HRT). Hysterectomy is a cure for pain in your pelvis as well especially if you have a condition called Adenomyosis.
Hysterectomy can be done using keyhole surgery (Total Laparoscopic Hysterectomy), vaginally or through a cut in your lower abdomen. The keyhole surgery has many advantages of quicker recovery and less complications.