Causes

Heavy menstrual bleeding can be caused by a variety of medical conditions and treatments. Women with heavy menstrual bleeding, however, are often found to have no underlying cause.

The following are some causes of heavy menstrual bleeding:

• Endometrial polyps and uterine fibroids – benign growths in and around the womb.
• Endometriosis – endometrium outside the womb, such as ovaries and fallopian tubes, is found in the body.
• Adenomyosis – when tissue from the womb lining becomes embedded in the wall of  the womb.
• Pelvic inflammatory disease – infection of the ovary, fallopian tubes, or womb. 

PCOS – polycystic ovary syndrome affecting the ovaries that causes irregular and heavy bleeding.

Intrauterine contraceptive devices (“the coil”) – these are devices that are implanted in the womb for contraceptional purposes. After insertion, you may experience heavier periods for three to six months.

• Endometrial hyperplasia – when the endometrium is thicker than usual in response to an excess of oestrogen.
• Endometrial cancer – This is very rare, but can also cause heavy periods.
• Disorders associated with blood clotting – including von Willebrand’s disease.
• Hypothyroidism – Underactive thyroid gland.
• The use of blood thinning medications, such as warfarin.
• A number of herbal supplements, e.g. ginseng, ginkgo, and soya, may affect your cycle and therefore affect your periods.

Diagnosis

Tests can be performed to find out what is causing heavy periods. In most cases, you will have a full assessment and physical examination, followed by blood tests, ultrasound scans, biopsies, and hysteroscopies based on your history

Treatment

Various treatment options are available for heavy periods. Various factors influence your choice of treatment, including your health, preferences, and the cause of your heavy periods. A cause for the bleeding will be identified and treated if one is found. It is sometimes impossible to identify the cause of heavy periods. These heavy periods can be treated with medications or surgery with the aim of reducing bleeding. Treatments may affect your fertility or make your periods stop completely.

Options for treatment include:

• Intrauterine systems (IUS) – a small device containing progesterone is placed inside your womb by a medical professional. It releases small amounts of progesterone locally onto the lining of the womb.
• Non-hormonal medications, such as tranexamic acid, non-steroidal anti-inflammatory drugs (NSAIDs), and mefenamic acid. NSAIDs reduce bleeding and can relieve period pain as well.
• Hormonal medications – such as progesterone tablets or combined oral contraceptives.
• Ablation of the endometrium – aimed at preventing the lining of the womb from thickening.
• Fibroid removal – myomectomy.
• Uterine artery embolisation – a procedure that reduces the size of fibroids in the uterus.
• Womb removal – hysterectomy.

To discuss diagnosis and treatment options, please book an appointment with our specialist.

To learn more about heavy periods, please click on https://www.nhs.uk/conditions/heavy-periods/

Dr Ibrahim Yahli MD MRCPsych