Heavy Menstrual Bleeding

Published 23rd February 2022 | Dr Ujwala Parashar

Heavy menstrual bleeding (previously known as menorrhagia) is a problem that is believed to affect 20 - 25% of women who menstruate; most commonly in the 30 – 50 year age group.

What is considered a normal period?

Your period should not disrupt your life. You should be able to wear a standard pad or tampon for 3-4 hours, and live your usual life without missing work, avoiding going out in public, or avoiding other activities you normally enjoy as part of your daily life.

How do you determine if you have heavy menstrual bleeding?

Heavy menstrual bleeding is most commonly defined by the amount of blood loss, or the duration of the period. The amount varies for each woman and can change at different life stages such as adolescence and the approach of menopause.
As a general guide to determine if you heavy menstrual bleeding, consider if your period significantly interferes with your daily life, and examine: 
  • Bleeding that lasts longer than 7 days
Blood loss
  • If a tampon or pad requires changing in under two hours or if large blood clots (bigger than a fifty cent coin) are present
  • If you have to double up on pads or change your pad or tampon during the night
  • If you have a menstrual flow that prevents you from participating in your normal activities
  • Bleeding through clothing despite protective layering
Other indicators for heavy menstrual bleeding can include pain and energy levels
  • You experience constant pain in the pelvis or lower abdomen for the duration of your period
  • You are tired and lack energy or have a shortness of breath
  • You feel weak or dizzy
  • You have chest pain

What causes heavy menstrual bleeding?

It can be difficult to diagnose the cause of heavy menstrual bleeding. Some known causes include: 
  • Uterine conditions such as fibroids or polyps
  • Endometrial hyperplasia
  • Cancer of the uterus of cervix
  • Pregnancy problems such as miscarriage or ectopic pregnancy
  • Hormone related problems
  • PCOS
  • Thyroid disorders
  • Obesity
  • Stress
  • Infections including STIs
Certain medicine can also be the cause of heavy menstrual bleeding including:
  • Birth control pills, IUDs and injectables
  • Blood thinners and aspirin
  • Certain breast cancer therapies

Is heavy menstrual bleeding serious?

Heavy menstrual bleeding can be serious if the blood loss results in anaemia- a condition that is caused from too little iron in the body. Without treatment, anaemia can be a life threatening condition. Anaemia can also include signs of “pica” a condition that has symptoms including hair loss, pale skin, and an urge to eat non-food items.
Heavy menstrual bleeding can also be an indication of other conditions such as cancer that require early medical intervention to prevent serious or life threatening outcomes.

How do you determine if you have heavy menstrual bleeding that requires further treatment?

In the first instance, you should attend your GP who will refer you to a specialist gynaecologist such as Dr Parashar. At your consultation, Dr Parashar will take your medical history asking about your menstrual cycle as well as your family member menstrual cycles. Before attending your consultation, it is useful to track your menstrual cycle by recording the dates and how heavy the flow is (i.e., the number of pads or tampons used).
Some questions you can expect to be asked include:
  • Your age when you started your first period
  • The length of your menstrual cycle
  • How long your period lasts
  • How many of the days of your period you consider to be heavy
  • If your period affects the quality of your life
She will also speak to you about your quality of life including diet, exercise, workplace, and stress levels and conduct a pelvic examination.
Other tests may also be required depending upon the severity of your symptoms and your age to determine the cause and effects of heavy menstrual bleeding. These can include:
  • Blood tests
  • Pap test
  • Sonohysterogram
  • Hysteroscopy
  • Transvaginal ultrasound
  • Endometrial biopsy
  • MRI

Management and treatment of heavy menstrual bleeding

The type of treatment recommended by Dr Parashar will be dependent upon the cause of your heavy menstrual bleeding as well as other factors including your general health, your age and your medical history; as well as your wants and needs. Some of the more common management and treatment strategies include:
Drug Therapy
  • Iron supplements: to assist in getting more iron into your blood if you are showing signs of anaemia.
  • Ibuprofen: to help reduce menstrual cramps and pain.
  • Birth control pills: to assist with menstrual regularity and reduce the amount of bleeding
  • Intrauterine contraception or IUC: to assist with menstrual regularity and reduce bleeding
  • Hormone therapy: to reduce the amount of bleeding

When is surgical treatment recommend?

If heavy menstrual bleeding is affecting your quality of life and causing negative impacts on your health and well-being but does not respond to drug therapy, Dr Parashar may recommend surgical intervention. This can include:
  • Dilation and Curettage (or D&C):  in this procedure, the top layer of the uterus lining is removed.
  • Operative hysteroscopy: to view inside the uterus and remove polyps and fibroids and correct any abnormalities as well as remove the lining of the uterus.
  • Endometrial ablation or resection. These are surgical procedures which are used to remove part of all of the uterus lining.
  • Hysterectomy. This is a major surgical procedure that involves the removal of the uterus. This procedure prevents you from having periods and you will not be able to become pregnant.
  • Uterine artery embolization (or UAE): this restricts the blood flow from fibroids and tumours.
  • Myomectomy: to remove fibroids

When should you seek treatment for heavy menstrual bleeding?

If heavy menstrual bleeding is impacting your quality of life, causing pain, or getting in the way of your physical and emotional well-being,  you should seek specialist advice.

Dr Ujwala Parashar, Obstetrician & Gynaecologist

Sam Samant

Dr Ujwala Parashar is a highly trained female obstetrician and gynaecologist with over 15 years of professional experience and training, practicing in Sydney's North Shore and Barangaroo. If you would like more information on conception, or if you are seeking obstetric options and advice, please contact us or call 1300 811 827 to arrange a consultation with her.