Menstrual Cycle Health
Heavy blood loss
- There seem to be many different definitions of what is classed as a heavy period. What qualifies as a heavy period?
The symptoms of heavy periods and menstrual cycle health vary from one person to another. The simple definition is if your heavy bleeding is impacting your life, you have heavy periods. Don’t plan your life around your periods, go and see your GP. Read more about the symptoms of heavy periods here.
- What causes heavy periods?
There are many causes of heavy periods, including fibroids, polyps and hormonal imbalances. In rare cases, the cause is attributed to a bleeding disorder or another medical condition. In 60% of cases, no clear cause can be identified. Read more about heavy bleeding here.
- What if my period is extremely heavy some months and regular others?
Erratic cycles that vary in flow from month to month are common, especially as a woman approaches her menopausal years. Heavy bleeding is not considered normal, even if it doesn’t occur every month.
- Who gets heavy periods?
1 in 5 women in the UK get heavy periods. Some women experience it from a young age, but many women only experience it after the ages of 30 or 40 e.g. after stopping the pill or after having children.
- What are the symptoms of heavy periods?
The symptoms of heavy periods vary between individuals, but can include heavy blood loss, prolonged periods, bleeding between periods, large blood clots during your period, anaemia and fatigue.
- How long will it take for my heavy periods to stop once treatment starts?
Different women need different treatments and not all treatments work for everyone, so you may need to try a number of different alternatives before you find the one that’s right for you. Your GP should be able to talk you through the potential options with you. Read more about treatment options here.
- The women in my family have a history of having hysterectomies for heavy periods. Are there alternatives?
Yes there are alternative treatments. If you are thinking about having a hysterectomy for heavy periods, please ask your GP about alternatives such as endometrial ablation. Read more about treatment options here.
- I don’t want a coil, what are alternative treatments are available for heavy periods?
Your GP should be able to talk you through the alternative treatment options that are suitable for you. These will be influenced by a number of things specific to you, including whether you have completed your family. Read more about treatment options here.
- Will I be able to have children after treatment?
Always discuss whether you would like to have children in the future when you talk to your GP about possible treatments for heavy periods. You would be unable to get pregnant after a hysterectomy and while it is possible to get pregnant following an endometrial ablation, it is very dangerous for both you and the foetus, so you should take contraception. Other treatments such as minimally invasive procedures to remove polyps or fibroids and non-hormonal treatments do not affect your ability to get pregnant. Hormonal treatments such as the Pill can be stopped if you decide you would like to try for children.
- What if the treatment I’m given doesn’t work?
If a treatment you’re trying doesn’t work, go back to your GP and discuss the alternatives. You don’t need to put up with it. There are a number of different treatments available.
- What if I don’t want to try the treatment the GP recommends?
If you’re not comfortable with the treatment that your GP recommends, ask them about the alternatives. This will be an easier conversation to have if you are aware of the different options, so taking the time to read the treatment section before your appointment could be helpful.
Seeing a Healthcare Professional for Menstrual Cycle Health
- What do I do if my GP is saying ‘it’s something you have to put up with’?
You do not have to ‘put up’ with heavy periods. There are treatment options available and your GP should be able to tell you what these are. If you don’t feel your current GP is willing to help you, trying seeing a different GP in your practice. See the Talking to your GP for advice and tools to help you get the most out of your appointment. You can also read about potential treatment options here.
- I’ve already seen my GP and what he gave me didn’t work. Is it really worth going back?
Yes. There are a range of treatment options available. Your GP should be able to discuss these with you. It’s time to stop living your life around your period! See the Talking to your GP for advice and tools to help you get the most our of your appointment. Read more about treatment options here.
- Can I see a gynaecologist without a GP referral?
You will need a referral from your GP to see a gynaecologist, even if you go private.
- What is an endometrial ablation?
An endometrial ablation is an innovative method of treatment during which the womb lining is removed. It is a one-off, quick, procedure. It may be performed under local or general anaesthetic.
- Is it right for you?
If your heavy bleeding is caused by fibroids, polyps or an infection alternative treatments will be offered. If you want to get pregnant, it is not appropriate as becoming pregnant after treatment poses serious risks. If you do have an endometrial ablation you will need to keep using contraception as pregnancy is possible.
Fibroid or Polyp Removal
- How are fibroids and polpys removed?
Women who suffer heavy periods caused by fibroids or polyps can have these removed during a minimally invasive procedure involving a hysteroscopy. New, minimally invasive technologies exist, e.g. Myosure, where you may even be able to be treated in an outpatient setting. You can be considered for treatment if you are not pregnant, do not have pelvic infections or abnormalities of the cervix and do not have cervical cancer.
- What are Fibroids?
Fibroids are non-cancerous growths that develop in or around the uterus (womb). Also known as myomas, leiomyomas or fibromas, they can occur singly or in large numbers. Fibroids are made up of muscle and fibrous tissues and vary in size – they can be as small as an apple pip, or as large as a grapefruit. There are different kinds, depending on where they are located.
- What are the symptoms of fibroids?
In general, fibroids are not dangerous. However, they can cause symptoms such as pressure on the bladder, lower back pain, pain during sex, period pain, bleeding between periods, and heavy bleeding.
Fibroids can also affect fertility as they can stop fertilised eggs embedding into the womb, so making it harder for you to get pregnant. If you do manage to get pregnant multiple fibroids can:
- block the vagina meaning a caesarean may be necessary to deliver the baby
- increase the risk of miscarriage
- What are polyps?
Polyps are benign submucosal growths that are attached to stalks. They can occur in the uterus (womb) and the cervix (neck of the womb). Polyps grow in the lining of the uterus (endometrium). They are covered with the same tissue and look like little toadstools. While women with polys often experience no symptoms, when they grow in size they can start bleeding.
Women are at increased risk of polyps in the uterus if they are aged between 40 and 50, are peri-menopausal, overweight, take tamoxifen (medication for breast cancer), have high blood pressure, or have polyps in the cervix.
- What is a hysterectomy?
A hysterectomy is a surgical procedure that may be required when there is no other alternative and/or previous treatments have failed e.g. for endometriosis, tumours, abnormal cells in the uterus, fibroids and pelvic floor problems. Usually, the cervix (neck of the womb) and the womb are removed. If the cervix is left intact, there is a 10 per cent chance of some bleeding at the times you would normally have your periods as the endometrium (womb lining) will remain in the cervix. If your cervix is removed, you will no longer be at risk of cervical cancer, so won’t need cervical smears. Your ovaries may also be removed.
- Immediate menopause?
Sometimes the ovaries are also removed in a hysterectomy. This greatly reduces the risk of cancer, but will affect your hormone levels. You will begin the menopause immediately and its associated symptoms such as hot flushes, vaginal dryness, dizziness and night sweats. You may require hormonal treatment.
- Types of hysterectomy
There are various surgical techniques for performing a hysterectomy. These are:
With this method, the uterus (womb) and the cervix (neck of the womb) are removed via the vagina. This technique is preferred because there are no visible scars and the recovery period is shorter than for the other methods, however it does not always work and is only possible if the uterus is not too big.
Key hole surgery
During keyhole surgery (a laparoscopic operation) a number of incisions are made in the stomach. These are used to insert a laparoscope, which allows the surgeon to monitor the operation on a screen. The uterus (womb) is removed in sections via the laparoscope or the vagina. The risk of infection is lower than with the standard method of surgery and the recovery time is shorter in comparison. The likelihood of permanent scars is also reduced.
With this method, the uterus (womb) is removed via an incision in the abdomen, just above the pubic bone. That horizontal incision is about 15cm long and can cause an unsightly scar. Sometimes a vertical scar is also necessary, for example, if the uterus is large or if cervical cancer has been diagnosed. The risk of complications is highest with this method, and the recovery period is the longest.
- Is a hysterectomy right for you?
In the case of benign conditions, it is important to consider the pros and cons of a hysterectomy carefully and explore other treatment options before making a decision. Thanks to innovative new treatment techniques e.g. endometrial ablation, a hysterectomy is not always necessary for heavy periods.
- What is hormone therapy?
The contraceptive pill and injections and hormonal coils e.g. Mirena, are intended as contraceptives. However, because of the hormones, they also have an effect on heavy bleeding and are often the treatment options first prescribed by GPs for heavy periods (menorrhagia). Hormone treatments with oestrogen and/or progestin (the pharmaceutical replacement for progesterone) can make the lining of the uterus thinner and thus reduce menstrual bleeding.
- What is non-hormonal therapy?
There are two main types of non-hormonal treatments your GP may prescribe, Non-steroidal anti-inflammatory drugs (NSAIDs) e.g. ibuprofen or tranexamic acid. NSAIDs, such as ibuprofen, mefenamic acid and naproxen are a suitable option for milder menorrhagia and can help to reduce the amount of menstrual bleeding, particularly in the first few days of the cycle. Tranexamic acid works by blocking the breakdown of blood clots. It can also help reduce menstrual blood loss and pain and only needs to be taken at the time of the bleeding.