What could be the cause of my heavy period?

Dear Dr Murage,

I am a mother of two now at 38 years. I am struggling with increasingly heavy periods. What could be the matter?

Answer

Many women experience abnormally heavy periods at some point in their reproductive years. Sometimes it’s just transient and appears to ease off spontaneously. But some will experience recurrent heavy bleeding, which at times will interfere with overall quality of life. If that happens, a gynecological evaluation is usually necessary. A specific diagnosis must be established, and appropriate treatment instituted.

Each woman has their own unique bleeding pattern, in terms of quantity and duration of the periods. Once you get used to your own pattern, it’s easy to judge when bleeding appears to be too much. In general terms, changing soaked pads several times in a day is way too much. So is bleeding that lasts well beyond one week. If too much blood has been lost, there may be symptoms of anemia that include unusual tiredness and shortness of breath.

Seek help

If you judge your bleeding to be too much, please see a gynecologist urgently. A review of your bleeding pattern will be done. You may also get an internal examination done, coupled with an update of your pap smear if this is due. Ultrasound imaging of the pelvis is usually necessary to assess the reproductive organs that include the uterus and ovaries. Some blood tests may also be necessary to check levels of certain hormones, and iron for those already anemic.

Many women, especially the younger ones, will not be found to have any physical cause for their heavy periods. In such cases, the cause is related to an imbalance of reproductive hormones. For some, there will be uterine causes like fibroids, a fairly common diagnosis. Yet others may have rarer conditions on the lining of the uterus which can cause heavy bleeding. Still rarer are gynecological cancers, though there may be additional symptoms in such cases. 

Once you get a specific diagnosis, appropriate treatment options will be advised. You may be suitable for non-hormonal treatment with tablets that limit the amount of bleeding every month. Sometimes, optimal control is only achieved with use of hormonal treatment. This is especially applicable in those not trying to conceive. Hormones can be given by mouth, via a patch on the skin, or even through a coil introduced into the uterus. Those with fibroids may require specific treatment that may include newer techniques of shrinking the fibroids, or even surgery. If you unfortunately get diagnosed with gynecological cancer, you will require referral to an appropriate specialist.

You should never allow your quality of life to be dictated by your bleeding pattern. Seek help as soon as you notice abnormally heavy bleeding. Your anxiety as to the cause of heavy bleeding can only be relieved following a diagnostic evaluation, and appropriate treatment.   

Dr Alfred Murage is a consultant gynaecologist and fertility Specialist; amurage@mygyno.co.ke