Heavy periods. What do I need to know?
Many people put up with heavy periods for years. It can be very helpful to talk through all the management options so you can feel in control rather than your periods ruling your life!
Heavy periods can be embarrassing and exhausting.
I am often amazed by what women put up with in regards to periods! Many times, it is only when a blood test shows low iron levels that they start talking about how their period is heavy and inconvenient.
They often say that they just thought it was “normal” and they had to put up with it. Many times, women have told me that they are worried to leave the house on the heaviest day of their period or have to choose their clothes carefully as the bleeding can soak through their sanitary protection and stain their clothes! Periods are normal but they shouldn’t take over your life.
Sometimes it hard to know how much other women bleed during a period so it is tricky to gauge if yours are “heavy” or not. As a general idea, most people can manage with a regular pad/tampon for 3-4 hours before changing it on their heaviest day. A super pad/tampon should be able to cope for 4+ hours.
If you need change your pad or tampon 1-2 hourly or have to wear a pad or period undies as well as a tampon in case of bleeding through, then you are experiencing “heavy periods”.
Do I need to do anything if I have heavy periods but they don’t really bother me?
Sometimes heavy periods can be a sign that something is not quite right with your general health. Especially if they have been getting heavier over the past 6-12 months or if there is any spotting or bleeding between periods or after sex.
Endometrial cancer or pre-cancerous thickening of the uterine lining can cause periods to get heavier or cause bleeding between periods. Non-cancer growths, like fibroids and polyps, can also cause periods to be heavier. An ultrasound of the uterus can usually show if any of these conditions are the cause of heavy periods.
Should I have a blood test if my periods are heavy?
Check your iron levels! Often over time the body can use up all its iron stores making blood cells to replace those lost each month with a heavy period. This can happen very slowly over months and may result in anaemia (low number of red blood cells in the body). Anaemia or low iron can have major effects on energy, mood and wellbeing. Returning iron stores to normal with oral iron supplements or an iron infusion can be a gamechanger for those who hadn’t realised their fatigue was due to heavy periods!
An underactive thyroid (hypothyroidism) may cause heavy periods, along with other symptoms like weight gain and fatigue. Getting the thyroid levels back in balance is usually fairly straightforward with medication and periods, weight and energy can return to normal quickly. Women with a family history of thyroid disease or coeliac disease are at increased risk of developing hypothyroidism and a simple blood test can pick this up easily.
1 in 1000 people have a bleeding disorder which can be the reason for heavy periods. Most don’t know it! This great Canadian screening tool can suggest if you might have a bleeding condition and need further assessment. https://letstalkperiod.ca/
If a few tests, show there is no concerning cause of heavy periods and the iron levels are fine then there is no need to “treat” heavy periods if you don’t want to. Often it is useful to take an iron supplement during the period to help keep iron stores up and definitely see a doctor if spotting or bleeding occurs between periods.
What can I do if I want to do something about heavy periods but I don’t want to go on the Pill?
Often people with heavy periods have been told that they should “Just go on the pill.” This can be a useful option for those who are happy to try that as the hormones in the oral contraceptive pills generally makes the lining of the womb get less thick each month and so the bleed in the hormone-pill break (the withdrawal bleed) is lighter. It is also usually possible to “skip” the inactive/sugar pills and stay on the active/hormone pills continuously which often can suppress menstrual bleeding for many months. Sometimes bleeding can still “break-through” on the active pills after a while but stopping the hormone pills for 4-7 days will usually get this under control again and not interfere with contraceptive protection. There is a common myth that it is not healthy to go too long without a bleed on the pill but many studies have shown that there are no harmful effects of taking the active/hormone pills continuously for 12 months or more.
However, there are many other options to reduce period bleeding other than the contraceptive pill…..
Anti-inflammatory medications like Naprogesic® or Ponstan®
These are used to help manage period pain but are also quite effective at reducing the amount of bleeding if they are taken for 3-4 days consistently from the very first sign of the period starting. The effect is usually not dramatic but tends to improve over a few months, so it is worth trying this for 3-4 months to see how much it can help. These are easily available from the pharmacy or supermarket, contain no hormones and do not interfere if you are trying to get pregnant.
Tranexamic acid
This is also a non-hormonal medication and is available on prescription from a GP. It can be very effective at reducing the amount of period blood lost each month. It should be taken at the first sign of bleeding and taken regularly, 2 tablets every 6 hours for the first 4 days of the period to have maximum effect which can be a bit inconvenient. Some women do report taking less tablets has still been helpful. I often find this a good option for people to try while considering other options or waiting for test results, so discuss this with your GP.
Contraceptive implant (ImplanonNXT® )
This match-stick sized implant is inserted under the skin in the upper arm and can reduce the amount and the number of days of bleeding for most people and provide very effective contraception for 3 years without having to take any pills. The progesterone hormone in the implant stops the ovaries from releasing eggs and also thins the lining of the womb.
Around 10-15% of users find that the number of bleeding/spotting days may actually increase. Although the bleeding is usually not heavy, many find this unsatisfactory and ask for the implant to be removed if this doesn’t settle after a a few months. Luckily, insertion and removal are straightforward and many GPs or women’s health clinics provide this procedure so it can definitely be worth a try!
Hormonal IUDs
These go by the names Mirena® and Kyleena® in Australia. They release a similar hormone to the implant but it is just released locally within the uterus cavity rather than into the blood stream. This means the dose of hormone that gets into the blood is extremely low and is generally too low to stop ovulation (releasing the egg from the ovary) so the body’s “menstrual cycle” continues but the hormone stops the uterus lining from thickening each month so there is only a little bit of blood to shed as a period.
The Mirena® IUD releases more progesterone each day than the Kyleena® and so it is usually a better option for those who are wanting to lighten or stop their period but both IUDs provide effective and reversible contraception. Mirena® can reduce period bleeding by around 90% which can be life-changing for those trying to manage heavy periods!
Different options suit different people at different stages of their lives.
It can be really helpful to talk through all the options with a women’s health doctor who can give you information relevant to your unique situation. The goal is for you to feel comfortable and in control managing heavy periods in the way that best suits you!
FOR MORE INFORMATION
See The Royal Australian College of Gynaecology information sheet on heavy periods
Family Planning NSW Factsheet on periods
