Heavy periods are very common for women in their 40’s
Heavy periods can have a big effect on a woman’s life at any age
An expert ultrasound scan will find many of the causes of heavy periods
Scanning is the key to understanding the cause of heavy periods
There are many options for treatment of heavy periods
Indications that periods are heavier than normal are:
- having to change sanitary products every hour or two
- passing large clots
- bleeding through to your clothes or bedding
- using two types of sanitary products together
Causes of heavy periods
The most common cause of heavy periods is the hormone imbalance that occurs for many women in their 40’s. At this age the ovaries become less responsive. This upsets the balance between estrogen and progesterone. Estrogen tends to make the lining of the uterus thicken. Progesterone counteracts this effect. Periods can vary from being very heavy one cycle to very light another. The length of the cycle may vary also.
Fibroids are the most common benign tumour in women and occur in up to 30% of women. For more detail on fibroids please press here. Fibroids that are lying under the lining of the uterus make periods heavy. This is because they interfere with the normal lining of the uterus. If the cavity of the uterus is very enlarged by fibroids, this can also make periods very heavy.
Endometriosis is a condition where we find tissue like endometrium outside the uterus. Endometrium is the name of the lining tissue of the uterus. Each cycle, the endometriosis responds to the ovarian hormones. During a period the endometriosis breaks down causing inflammation and heavy painful periods.In endometriosis, periods become progressively heavier and more painful. This often occurs between 20 and 30 years of age. Pregnancy is very good treatment for endometriosis. So it is less common in women with children.
Adenomyosis is like endometriosis. Here, we find abnormal tissue that looks like the lining of the uterus, within the muscle of the uterus. The tissue responds to the hormones of the ovarian cycle. With each period this tissue breaks down causing inflammation. This causes the periods to be very painful and heavy.
Uterine polyps occur when the lining of the uterus or womb thickens locally. The uterus contracts in waves which pulls on the thickened area. This pulls it up into a little polyp, or protrusion of the endometrium. Periods may be heavy because of polyps
Generalised bleeding disorders, are often associated with heavy periods. An example of this is von Willebrand disease. We don’t often test for these, unless there is a history of other bleeding problems.
These can also cause heavy periods. Your doctor will be able to tell how best to manage heavy periods if you are on anticoagulants.
Occasionally, heavy periods are a sign of a cancer. Endometrial cancer before the menopause presents in this way. Cancer of the cervix and ovary can also present with heavy periods.
What will happen during your clinic visit?
We usually arrange a pelvic ultrasound at the start of your first clinic. This looks for causes of your heavy periods. An ultrasound scan can visualise uterine polyps, fibroids and sometimes endometriosis. The ultrasound also examines the ovaries for cysts.
We do a pelvic examination. We can see if there is an abnormality of the cervix or vagina. We sometimes take a smear test at the same time. We usually do a blood test to check for other causes.
We can then plan how best to treat the heavy period.
Treatment of heavy periods
Endometrial ablation use an energy device to “cauterise” the lining of the uterus. The lining of the womb remains very thin. When the time for a period comes, there is nothing to shed. This treatment is only used for women who are sure they don’t want any more children. Only one treatment is necessary.
The Mirena coil is a very effective contraceptive device. It also makes periods dramatically lighter and less painful. It works by releasing a small dose of progesterone into the lining of the uterus. This stops the lining thickening during the cycle. When the time comes for a period, the lining is very thin, and there is nothing to shed. The Mirena coil provides completely reversible contraception. Periods and fertility go back to normal as soon as we remove the Mirena.
Oral contraception usually makes periods lighter and less painful. This is a useful side effect of the pill. The minipill, Cerazette, often causes periods to be very light or even non-existent. It sometimes causes irregular bleeding.
Tranexamic acid is a medicine that reduces bleeding in many situations. It stabilises blood clots and reduces menstrual bleeding by about 40%. You take the tablets only during your period.
We call a group of anti-inflammatory medicines NSAIDs. This is short for non-steroidal anti-inflammatory medicines. We use them to treat heavy periods. You start taking them at the beginning of the period. They used continually through the period until it starts to ease off.