If you’re going through six or seven tampons a day, or if you’re experiencing heavy menstrual periods with clots, you may have a condition called menorrhagia. Here’s what to know about prolonged and heavy periods, and how this GP in Singapore can help. (Yep, no need to see a specialist!)
How do I know if I have heavy periods?
Every woman’s flow and menstrual cycle are different. It can be hard to know if you’ve got a light, normal or heavy period unless you talk with your doctor.
DR REBECCA DALY is a UK-trained GP at International Medical Clinic (IMC) Katong. She commonly gets asked what constitutes a heavy period, as it can be difficult for patients to define.
A period is considered heavy, she says, if it causes one or more of the following:
- frequent changes of tampons or pads every two hours or more;
- flooding into clothes or bedsheets;
- needing double sanitary protection with tampons and pads;
- passing large period blood clots;
- menstrual bleeding that lasts more than seven days; and
- menstruation that affect normal activities such as school, work or sports.
Dr Daly suggests keeping a diary or using one of the many apps to track your menstrual periods.
What causes heavy periods?
There are many reasons for heavy periods, and it’s a common reason for women to see their GP. In fact, one in three women are affected by heavy periods during their lifetime.
But, while heavy flows and menstrual cramps can be common experiences, menstrual periods that prevent you from doing everyday activities are not normal. Women who experience unusually heavy menstrual bleeding that impacts their daily lives may have a condition called menorrhagia – the medical term for heavy or prolonged periods.
Common causes of menorrhagia
In more than half of women, there is no obvious cause. This is called dysfunctional uterine bleeding.
“In such cases, there is no abnormality of the womb, ovaries or hormones. Ovulation occurs as expected and the periods are regular,” says Dr Daly. “Dysfunctional uterine bleeding is common in the first few years after starting periods, although this generally settles down in time.”
Other common causes of menorrhagia include:
- fibroids, which are non-cancerous growths in the muscle of the womb;
- infection of the womb;
- polyps (small, benign lumps) in the womb or cervix;
- a hormonal imbalance or thyroid issues;
- certain medications that can make periods heavier, including chemotherapy, the copper coil and warfarin;
- rare blood clotting disorders; and
- rarely, endometrial cancer.
Additionally, many women experience heavier menstrual bleeding after taking the combined contraceptive pill for a prolonged period.
It’s important to note, however, that bleeding after intercourse, bleeding between menstrual periods or irregular periods are not normal. They may indicate a serious underlying cause and a doctor should be consulted.
Is menorrhagia dangerous?
Heavy periods are not dangerous, but they can be a nuisance, particularly when living an active, outdoor lifestyle in Singapore.
“Many of my patients describe having to source super tampons and pads, wear back-up period pants, set a middle-of-the-night alarm to change their moon cup or cancel certain activities during their period,” says Dr Daly.
The common consequence of heavy menstrual bleeding is becoming anaemic, which can creep up over time if left unchecked. Low iron levels can lead to headaches, fatigue, hair loss and breathlessness.
How your GP can help with menorrhagia
Your GP may order blood tests, such as checking for anaemia, thyroid problems, clotting disorders if suspected and, in some cases, hormonal blood tests.
According to Dr Daly, most women benefit from a pelvic ultrasound scan to check the lining of the womb and look for underlying causes such as fibroids or endometriosis.
If your GP suspects a serious underlying cause for your bleeding, you may need to be referred to a gynaecologist for a biopsy of the lining of the womb or a hysteroscopy (a thin telescope is passed throughout the vagina and cervix into the womb to visualise the lining and take biopsies if indicated).
Menorrhagia treatment options
Your GP will discuss several treatment options with you, depending on your type and duration of bleeding, any underlying causes identified, your age and your desire for future pregnancies.
Once a serious condition has been excluded, you may decide that you prefer to avoid treatment altogther, particularly if your symptoms are not significantly impacting your quality of life.
If you do decide to move forward with menorrhagia treatment, there are a variety of methods to choose from. This includes hormonal and non-hormonal medical treatments, as well as surgical procedures.
Non-hormonal medical treatment for heavy periods
One commonly prescribed drug called tranexamic acid can be taken three times a day during the first few days of your menstrual period. It can reduce the amount of blood lost, but not the duration of bleeding.
Another tablet used to treat menorrhagia is an anti-inflammatory medicine called mefenamic acid. This can be particularly beneficial if your periods are painful, says Dr Daly.
Birth control pills and other hormonal treatments for heavy periods
The birth control pill is an effective treatment for menorrhagia that can also improve period pains, and provide reliable contraception if required. The combined oestrogen and progestogen pill is taken daily for three weeks, followed by a week off during which a withdrawal period occurs.
The disadvantages, however, include a slightly higher risk of thrombosis (blood clots in the leg or lung) and breast cancer. It can also cause hormonal side effects such as breast tenderness, nausea, mood changes and acne, says Dr Daly.
The mini pill
The mini pill is another type of birth control pill. It has progestogen only and is therefore generally safer for women with risk factors for clots or breast cancer. This birth control pill is taken daily without a break, so it may stop your menstrual periods altogether, and gives reliable contraception if needed. However, when taking the mini pill, it’s not uncommon to experience irregular bleeding in the first few months, or hormonal effects such weight gain and mood changes.
Other long-term progestogen-only contraception includes the Depo injection (once every 12 weeks) and the contraceptive implant, which is placed in the arm and lasts three years.
The Mirena coil
This contraceptive coil with progestogen is placed in the womb and can be fitted by your GP! The amount of hormone released each day is very small, yet it works directly on the womb to thin the lining, explains Dr Daly. “The Mirena coil is an extremely effective method of treating heavy periods. Studies show bleeding is reduced by 80 percent at six months and 90 percent at one year, with periods stopping altogether for most women. It’s particularly beneficial for women who need long-term contraception, as it lasts five years. It also has lower hormonal side effects than other methods.”
Surgical treatment for menorrhagia
If the above treatment options don’t work for you, or if you can’t tolerate hormones, you may need a referral to a gynaecologist. Surgical options such as endometrial ablation (a procedure that destroys the lining of the uterus) or, the last resort, a hysterectomy, can be discussed for women who are not planning any future pregnancies.
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