Dr Glenda McLaren
Obstetrician & Gynaecologist
Dr Glenda McLaren
Obstetrician & Gynaecologist

How can I tell if I have Heavy Menstrual Bleeding, and what treatment options are available?

What is Heavy Menstrual Bleeding or Menorrhagia?

Heavy Menstrual Bleeding

Heavy periods or heavy menstrual bleeding, also known as menorrhagia, are common and affect around one in three Australian women, typically in the 30-50-year-old age group.  

Unfortunately, heavy periods can enormously impact some women’s day-to-day lives, with pain and discomfort that is detrimental to a woman’s physical, social, and emotional quality of life. 

What is the medical definition of Menorrhagia?  

Menorrhagia is heavy or prolonged menstrual bleeding. Many women have this type of abnormal uterine bleeding. It can be related to a number of conditions including problems with the uterus, hormone problems, or other conditions. While heavy bleeding can make it tough to take part in normal daily life at times, there are treatments to help. 

Source: Johns Hopkins (https://www.hopkinsmedicine.org/health/conditions-and-diseases/menorrhagia) 

There is a range of different, common gynecological conditions that could cause heavy menstrual bleeding. It’s important to reach an accurate diagnosis, and so, along with a consultation, there may be other tests or investigative procedures that are required.  

After a medical diagnosis, the good news is that most related conditions can generally be treated or improved. It is important to establish the cause early, so effective and personalized treatment strategies can be employed. Effective and minimally invasive treatment options usually rapidly improve symptoms and iron deficiency and restore quality of life. 

Bloom Women’s Health gynaecologists have extensive experience in diagnosing and managing heavy menstrual bleeding and will support you with detailed discussions about treatment options. 

Many women we help at Bloom Women’s Health commonly delay seeking help for several years, they often normalise their experience, reflecting general societal low awareness of heavy menstrual bleeding as being treatable. This comes with significant emotional impacts such as anxiety, depression, lack of confidence and withdrawal from social activities." - Dr Huda Safa

Why many women experience Heavy Menstrual Bleeding, but don’t seek help?

Many women tolerate heavy bleeding during their period and delay consulting their GP or Gynaecologist, because they assume their heavy periods are ‘just a normal part of being a woman,’ or don’t have any comparison to their own lived experience. 

Some women may have been previously dismissed by health professionals about their period discomfort, or assumed changes in their period were merely a normal part of the ageing process. Sometimes women have previously made a switch in their contraceptive pill in consultation with their GP and assume there is nothing else to be done to resolve the recurring problem. Or some might think that involving a women’s health specialist like a gynaecologist isn’t necessary. Still other women may simply not feel comfortable talking about their periods.  

At Bloom Women’s Health, our compassionate Gynaecologists have deep understanding of period problems at various stages in a woman’s life. We walk the journey with you, tailoring management plans to your individual needs. 

Heavy Menstrual Bleeding

Bloom Women’s Health female-led team will listen to women talk about issues with their periods

At Bloom Women’s Health, we understand the many challenges women face when assessing and managing their menstrual cycles. We know how busy modern women’s lives are, and how our health can take a ‘back seat’ to life’s other priorities.  

Bloom Women’s Health is led by female gynaecologists who specialise in women’s health and are well-known for their collaborative and compassionate approach. We offer women a safe and supportive environment where there are no ‘silly questions’ – we take the time with our patients to listen to their symptoms and explain all diagnostic and treatment options carefully. 

All the gynaecologists and other women’s health professionals at Bloom strive to provide welcoming, judgement-free consultations with her patients. They are known for their warm and compassionate nature that helps ease womens’ anxiety. 

Signs and symptoms of Heavy Menstrual Bleeding

Women may ask themselves ‘What constitutes ‘heavy’ bleeding – how heavy does it need to be?’ The most common explanation of heavy bleeding is that it is excessive and/or prolonged menstrual bleeding, that negatively impacts a woman’s daily life.  

It can be challenging to judge whether your bleeding is ‘too heavy,’ so it is helpful to assess whether your period is also having an impact on your quality of life. For example, if your heavy period is causing you to avoid leaving the house, take time off work, or interrupt your daily routine. 

The following physical signs also might indicate you are experiencing heavy bleeding: 

  • Bleeding not contained within a pad or tampon (such as bleeding through to your clothes) 
  • Changing a pad/tampon frequently (such as every hour)  
  • Blood clots greater than a 50-cent piece in size  
  • Bleeding for more than a week  
  • Feel fatigued or dizzy, and/or looking pale 
  • Having low iron levels (because of the blood loss) 
  • Experiencing cramping and pain in the lower abdomen 
  • Prolonged and heavy return of menstruation after childbirth 

Causes and conditions related to Heavy Menstrual Bleeding

There are generally three reasons for heavy menstrual bleeding: hormones, changes within the uterus and blood disorders (though these are less common). Most causes are treatable and not life-threatening. 

Heavy menstrual bleeding does not necessarily indicate a woman has abnormalities in their uterus – the bleeding can be related to hormonal or chemical levels in the endometrium (the internal lining of the uterus). 

However, sometimes heavy menstrual bleeding can be more complex, and Dr Huda Safa says that it is particularly important for some women not to delay seeking medical assessment, or ignore heavy menstrual bleeding symptoms. “In some women, there are potential risks of precancerous or cancerous changes in the uterus, such as women over the age of 45 years, those who are over 90kg in weight or have a family history of endometrial, ovarian or bowel cancer and women with untreated polycystic ovarian syndrome. It is particularly important that these women consult a Gynaecologist early in the course of their period problems.” 

Common reasons women experience heavy periods can include: 

  • Fibroids – non-cancerous (benign) growths or lumps within the uterus wall. 
  • Polycystic ovary syndrome (PCOS) – some women can have heavy menstrual bleeding if the lining of the uterus is thickened; this can lead to pre-cancerous or cancerous changes. 
  • Polyps – usually non-cancerous growths in the endometrium that look like a large ‘teardrop’ of tissue. 
  • Endometrial hyperplasia – an overgrowth of the endometrium, which can progress to cancer. 
  • Adenomyosis – endometrium growing in small pockets inside the muscle layer of the uterus. 
  • Endometrial cancer – cancer of the uterus 

How is Heavy Menstrual Bleeding diagnosed?

If you are worried about your heavy periods, it is best to arrange a consultation with your GP, who will then likely refer you to a Gynaecologist, such as one of the Gynaecologists at Bloom Women’s Health. 

At Bloom Women’s Health, we will discuss your symptoms and general health history and decide the most appropriate diagnostic approach for you. This could involve: 

  • Blood tests  
  • An examination of your vagina and cervix. We may take a tiny sample of your cervix for testing (called a cervical screening test) 
  • An ultrasound of your pelvis  
  • Further investigations may include a hysteroscopy and/or a curette 
Signs and symptoms of Heavy Menstrual Bleeding

What Heavy Menstrual Bleeding treatment options are available?

Management options will depend on the woman’s preference, but also the clinical situation. At Bloom Women’s Health, our caring female Gynaecologists will always discuss your options with you and explain procedures in detail, before moving forward with an agreed treatment approach. 

Medication

Your Gynaecologist may prescribe medication to help reduce the amount of bleeding, and/or ease pain and discomfort. Common medications prescribed to manage Heavy Menstrual Bleeding include:  

  • The oral contraceptive pill 
  • The insertion of a Mirena® intrauterine device (IUD)   
  • Progesterone only pills  
  • Non-hormonal pills. 
Medication

Procedures

In some cases, the woman may require a surgical procedure instead of or in addition to management with medication. At Bloom Women’s Health, we will take the time to carefully explain the potential risks and benefits of the appropriate procedure/procedures before you make your decision. 

Three common procedures include: 

  • Endometrial Ablation – NovaSure 
  • MyoSure removal of fibroids 
  • Hysterectomy 

For clients at Bloom Women’s Health, Novasure and Myosure procedures are Day Surgery Cases and usually performed at Spring Hill Specialist Day Hospital. Hysterectomy, usually offered as a laparoscopic procedure requires over-night stay and is performed at Mater Private Hospital, South Brisbane. 

Endometrial Ablation (NovaSure)

NovaSure® is a quick, safe, and simple procedure to lighten or stop your periods, without the side effects of hormones or the risks of hysterectomy. 

This is a day surgery procedure where a hysteroscopy is performed to check the lining of the uterine wall, small polyps or fibroid growths may be removed at the same time. 

The ablation procedure follows in the same sitting, where the uterine lining is exposed to heat which turns the lining into scar tissue, thus limiting or ending the bleeding. 

This procedure works by purposely damaging the lining of the uterus and is only suited to those who do not wish to have children after the procedure. This procedure is not a contraceptive one. 

MyoSure

MyoSure is a tissue removal system that is ideal for the removal of benign tissue growths like polyps or fibroids inside the uterus. It is usually a day procedure. 

It is highly effective in reducing heavy menstrual bleeding and is ideal when the main factor driving heavy bleeding is fibroid growth inside the uterus. 

Hysterectomy

A hysterectomy is a surgical procedure to remove the uterus. It offers a complete cure for menstrual bleeding but involves major surgery and a period of recovery. 

If a hysterectomy is performed, the ovaries are left in if they are normal. The ovaries can be removed at the time if there are increased risk factors including age, family history, and personal preference. Hysterectomy is usually performed as a minimally invasive procedure using a laparoscopic approach (keyhole), where an overnight hospital stay is usually sufficient.  

Occasionally, an abdominal hysterectomy (an incision is made in the lower abdomen to access the uterus) will be necessary, especially in the presence of a large fibroid uterus. 

A period of 4-6 weeks will be required for recovery from a hysterectomy, depending on the type of hysterectomy performed. 

At Bloom Women’s Health, all patients undergoing surgical management will receive post-operative review, by phone or in person depending on the intervention they received. 

Do you need help with heavy menstrual bleeding?

The dedicated Bloom Women’s Health team provides Brisbane patients a range of support on these important health opportunities and challenges facing women every day along their health journey, such as heavy menstrual bleeding. 

Our friendly reception team is here to assist you with your appointments, referral questions and administrative enquires. Contact us today to discuss your health needs and to make an appointment. 

  • Speak to us on the phone: 07 3832 7399 
  • Follow us on Social Media on Facebook @BloomWomensHealthQLD and Instagram @bloomwomenshealthqld 

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