Heavy periods

Heavy Periods (Menorrhagia)

Heavy periods, medically referred to as menorrhagia, describe excessive menstrual bleeding that is either prolonged (lasting more than 7 days) or abnormally heavy (needing to change sanitary products every 1–2 hours or passing large blood clots). While some variation in menstrual flow is normal, menorrhagia can significantly affect a woman’s quality of life and may indicate an underlying medical condition.

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Causes

Heavy periods may result from a wide range of gynecological, hormonal, or systemic conditions:

• Hormonal imbalance – Excess estrogen or low progesterone can cause endometrial overgrowth and heavy shedding.

• Uterine conditions – Fibroids, polyps, adenomyosis, endometrial hyperplasia, or endometrial cancer.

• Ovulatory dysfunction – Anovulatory cycles are common in adolescents and perimenopausal women.

• Bleeding disorders – Von Willebrand disease, platelet function defects, or anticoagulant therapy.

• Pelvic infections – Pelvic inflammatory disease (PID).

• Thyroid disease – Hypothyroidism and hyperthyroidism can both disrupt menstrual flow.

• Intrauterine devices (IUDs) – Especially copper IUDs.

• Medications – Anticoagulants, hormonal drugs, or chemotherapy agents.

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Symptoms

• Soaking through sanitary products every 1–2 hours

• Passing clots larger than a coin

• Menstrual bleeding lasting longer than 7 days

• Needing to use double protection (tampon + pad)

• Night-time changes of protection

• Symptoms of anemia (fatigue, dizziness, shortness of breath, pallor)

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Diagnosis

A thorough evaluation is essential to determine the underlying cause.

• Medical history and menstrual diary

• Pelvic examination

• Blood tests – CBC (to check for anemia), thyroid function tests, coagulation profile.

• Ultrasound scan – To check for fibroids, polyps, or other uterine abnormalities.

• Hysteroscopy / Endometrial biopsy – If endometrial pathology or malignancy is suspected.

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Treatment

Management depends on the underlying cause, severity, age, and fertility desires:

1. Medical Treatments

• Non-hormonal options

  • Tranexamic acid (1 g orally 3–4 times daily during menstruation): antifibrinolytic that reduces bleeding.

  • NSAIDs (e.g., Mefenamic acid 500 mg orally 3 times daily during menstruation): reduce prostaglandins and bleeding volume.

• Hormonal options

  • Combined oral contraceptive pills (COCPs) – Regulate cycles, reduce flow.

  • Oral progestogens (e.g., Norethisterone 5 mg orally 2–3 times daily, days 5–26 of cycle).

  • Levonorgestrel intrauterine system (LNG-IUS, e.g., Mirena) – Very effective long-term therapy.

  • Injectable progestogens (e.g., Medroxyprogesterone acetate 150 mg IM every 12 weeks).

2. Surgical Treatments

• Endometrial ablation – Destroys the uterine lining to reduce bleeding.

• Hysteroscopic polypectomy or myomectomy – If fibroids or polyps are present.

• Uterine artery embolization (UAE) – Minimally invasive option for fibroids.

• Hysterectomy – Definitive treatment, only if childbearing is complete.

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Home and Lifestyle Measures

• Keep a menstrual diary to monitor flow and treatment response.

• Ensure adequate iron intake (iron-rich foods or iron supplements to prevent anemia).

• Maintain a healthy weight – obesity worsens estrogen imbalance.

• Avoid overuse of NSAIDs (other than prescribed for menorrhagia).

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Precautions

• Women with very heavy bleeding should seek urgent medical care if they develop dizziness, fainting, or very low hemoglobin levels.

• Any woman over 45 years with new-onset heavy bleeding should be evaluated for endometrial cancer.

• Women with a family history of bleeding disorders should be screened.

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Drug Interactions

• Tranexamic acid should not be used with combined hormonal contraceptives due to increased clotting risk.

• NSAIDs may interact with anticoagulants (warfarin, DOACs) increasing bleeding risk.

• Hormonal contraceptives may interact with enzyme-inducing drugs (e.g., rifampicin, certain anticonvulsants), reducing effectiveness.