Heavy Uterine Bleeding

What is heavy uterine bleeding?

Heavy uterine bleeding (also known as menorrhagia) is a common problem in the 30-50 year age group.

For about 50 per cent of women with heavy bleeding the cause is unknown (dysfunctional uterine bleeding). For the other 50 per cent the cause may be related to:

  • Endometrial  polyps  (thickening of the endometrium, usually benign, looks like a large ‘tear drop’ of tissue)
  • Endometrial hyperplasia (generalised thickening of the endometrium which can progress to being cancerous)
  • Endometrial cancer (cancer of the uterus)
  • Fibroids (benign tumours or lumps originating from the muscle of the uterus)
  • Adenomyosis (endometrial cells growing in small pockets inside the muscle layer of the uterus causing pain and bleeding)
  • Intra uterine device (a contraceptive device also known as an IUD), usually of the non-hormone releasing type

NOTE: The endometrium is the lining of the uterus

If, after tests are performed and no cause for the heavy bleeding is found, your health practitioner might tell you that you have dysfunctional uterine bleeding.

How do I know if my bleeding is too heavy?

It is very difficult to work this out, but if your bleeding is becoming heavier than usual, interfering with your daily living, or worrying you, then seek help.

What signs should I look for?

  • Unusual increase in blood loss
  • More than seven days of bleeding
  • Bleeding or flooding not contained within pads or tampons (especially if wearing the largest size)
  • Clots greater than a 50 cent piece in size
  • Dizziness, fatigue or looking pale during your period
  • Waking up at night several times to change pads/tampons

How may it affect me?

  • You may feel fatigued or dizzy, or look pale
  • You may be low on iron because of the blood loss
  • You may become very self-conscious of the heavy bleeding and fear the bleeding will come through your clothes – especially when you are in public
  • You may prefer to stay at home because of having to change pads or tampons frequently

Other possible causes

  • Underactive thyroid gland (hypothyroidism)
  • Bleeding disorders where excessive bleeding can occur e.g. Von Willebrand disease, but is more common in teenagers
  • Chronic kidney disease

What therapies are available?

  • Your health practitioner may recommend iron therapy. This is usually a tablet that is taken daily
  • Your health practitioner may prescribe other medications such as:
    • Certain anti-inflammatory drugs to reduce bleeding and period pain
    • Tranexamic acid to reduce the bleeding
    • An IUD, releasing a hormone which thins the endometrium and reduces bleeding up to 95 per cent after 12 months of use
    • The contraceptive pill to reduce period pain and provide contraception (blood flow can be reduced by up to 50 per cent by using the pill)
    • Progestogens (synthetic forms of progesterone, one of our female hormones) to reduce blood loss by about 30 per cent
  • Surgery is offered if medicines have failed to solve the problem. Surgery is recommended if:
    • Medicines fails to reduce bleeding
    • There are other symptoms, such as pain
    • You discuss the option with your health practitioner and you both feel it is the most appropriate option. Your health practitioner may describe and offer endometrial ablation or hysterectomy.

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