I was out with friends recently and ‘how much flow is normal?’ came up. Apart from my peer group, it’s also one of the most common questions I receive from patients.
Every woman is different in terms of how much blood she loses during her menstrual period. Many women find they have a light start, medium to heavy mid-cycle, and then light again for the last day or two.
If your period is impacting your quality of life, then you’re considered to have ‘heavy menstrual bleeding’. I really like this patient-centred approach, because you know your body best and how heavy bleeding can impact your daily routine and lifestyle.
When should you be worried?
Here are a few signs you should watch out for:
- On the hour: soaking one or more pads or tampons every hour for several consecutive hours
- Doubling-up: using a tampon and a pad
- Night shift: having to wake up during the night to change your pad or tampon
- Length: your periods last longer than a week
- Clots: passing large clumps of blood or clots during your period
Heavy menstrual bleeding effects approximately 30 women in 100 between the ages of 31 and 50. If you suspect you may have heavy menstrual bleeding, arrange to see your family doctor, who may refer you to a gynaecologist. It’s a good idea to keep a record of your period, including when it starts, how many pads or tampons you use on each day of your period, and so on.
Pinpointing a cause
Your doctor may order some tests to see if they can pinpoint a cause for your heavy bleeding:
- Pap test – this test looks for infection, inflammation or pre-cancerous changes of the cervix
- Blood tests – these will provide information on whether you may have an iron deficiency or maybe your thyroid isn’t functioning properly
- Endometrial biopsy – your doctor may take a sample from your uterus and send to the lab for testing; the biopsy tests for pre-cancer or cancer of the uterus
- Ultrasound – this will look at your uterus, ovaries and pelvis. You may also need a special kind of ultrasound called a sonohysterogram which involves placing fluid in the uterus so growths such as fibroids or polyps can be seen more clearly
Depending on what is found, your doctor may suggest different approaches to treating your heavy bleeding. Treatment may include medication, like ibuprofen, or putting you on an oral contraceptive or “pill”. Your doctor may also suggest inserting a hormonal IUD. There is also something called tranexamic acid, which you take only during your period and helps reduce blood loss.
Surgical treatment may also be explored if medication isn’t an option or doesn’t address the bleeding. Here are some of the options your doctor may consider:
Hysteroscopy: This procedure is considered both diagnostic and therapeutic, meaning your doctor can see what’s going on and also possibly treat you at the same time. Hysteroscopy involves placing a camera inside the uterus, which can be done with sedation or in the operating room under a general anaesthetic. If there are growths inside the uterus that are causing the bleeding, like polyps or fibroids, they can be removed during the hysteroscopy.
Endometrial ablation: This procedure involves burning the lining inside the uterus and is an option to consider if you’ve finished having children and have no future plans for pregnancy. It can be done either with hysteroscopy (covered above) under general anaesthetic in the operating room, or with some newer devices while you’re sedated.
Hysterectomy: Hysterectomy is a procedure which removes your uterus and can be done either through a large incision in the abdomen or laparoscopically through small key hole incisions. The laparoscopic approach, if possible, has several benefits, including less pain, a shorter hospital stay and also allows you to return to work faster.
Myomectomy: If fibroids are causing the bleeding, then myomectomy, or having the fibroids removed, may help reduce bleeding. This can be done with hysteroscopy, laparoscopy or through a large incision.
Remember, if you suspect you may have heavy menstrual bleeding, arrange to see your family doctor as a good starting point.