Understanding Your Period: What's Normal and When to Be Concerned

During a normal period, women lose about 6-8 teaspoons of blood (30-40 ml), and the bleeding usually lasts around 5 days (but can last up to 8). However, periods can vary, and there are some signs you should watch out for that may suggest something is wrong.

Red Flags to Watch Out For

If you notice any of the following, it’s important to talk to your doctor:

• Heavy blood loss: Losing more than 5-6 tablespoons of blood (about 80 ml) during your period.

• Large clots: Passing blood clots larger than a 50-cent coin.

• Frequent pad or tampon changes: Needing to change your pad or tampon every hour due to heavy bleeding.

• Nighttime disruptions: Waking up to change your pad or tampon because of heavy flow.

• Bleeding through clothing or bedding.

• Prolonged bleeding: If your period lasts longer than 8 days.

Other Red Flags: Increased Risk of Cancer

Some women may be at a higher risk of developing endometrial (uterine), ovarian, or bowel cancer. You may be at risk if you:

• Are over 45 years old

• Weigh over 90 kg

• Have never had children

• Have a family history of endometrial, ovarian, or bowel cancer

• Have Polycystic Ovarian Syndrome (PCOS)

• Carry a gene that increases your cancer risk

If you fall into one or more of these categories, it’s even more important to keep an eye on changes in your periods and discuss them with your doctor.

How Heavy Periods Can Affect You

Heavy periods can cause low iron levels and fewer red blood cells, which can lead to:

• Feeling tired easily

• Feeling weak or dizzy

• Shortness of breath

• Chest pain (in more severe cases)

If you’re experiencing any of these symptoms, seek medical advice. There are many treatment options, and most cases can be managed with medication or surgery.

Causes of Heavy Periods

There are several reasons why you might have heavy periods, including:

1. Hormonal Imbalance

When hormones are out of balance, it can lead to heavy bleeding. Conditions that can cause this include:

• Polycystic Ovarian Syndrome (PCOS)

• Perimenopause (the time just before menopause)

• Underactive thyroid

2. Uterine Issues

Problems with the uterus can also cause heavy bleeding, such as:

• Fibroids: Non-cancerous growths in the uterus that can cause heavy periods, pain, or fertility problems.

• Polyps: Small, non-cancerous growths in the uterus lining that can cause heavy bleeding or bleeding between periods.

• Adenomyosis: When the lining of the uterus grows into the muscle wall, causing heavy periods.

• Cancer or precancerous changes: Though rare, these conditions can cause heavy menstrual bleeding and need immediate attention.

3. Blood Clotting Disorders

Women who have medical conditions that affect blood clotting or who take medications like blood thinners may experience heavier bleeding.

4. Other Causes

Other, less common causes include:

• Liver and kidney conditions

• Hormonal contraception (e.g., birth control pills) can sometimes cause heavier periods.

What Tests Might Be Needed?

If you're experiencing heavy periods, your doctor may recommend some tests to figure out the cause:

1. Examination: Your doctor may check if the bleeding is coming from the cervix instead of the uterus, similar to a Pap smear.

2. Blood tests: These can check for anemia, iron levels, thyroid problems, or a bleeding disorder.

3. Ultrasound: An internal scan of your uterus and ovaries to detect fibroids or polyps.

4. Internal swabs: These can check for pelvic infections.

5. Biopsy: A small sample of the uterine lining may be taken to check for any precancerous or cancerous changes.

6. Hysteroscopy: A procedure using a small telescope to look inside the uterus and take samples, if needed. It can be done with or without anesthesia.

Treatment Options for Heavy or Prolonged Periods

Treatment depends on the cause, your future pregnancy plans, and other health conditions you might have. Treatments are generally divided into medical or surgical options.

Medical Treatments

1. Hormonal Treatments: These treatments help balance hormones, which can reduce bleeding. The most effective option is an intrauterine device (IUD) that releases progesterone, reducing blood loss and preventing pregnancy. It can stay in place for up to 5 years.

   • Other hormonal options include the oral contraceptive pill, which can be taken continuously without breaks, as well as the vaginal ring, injections, or skin patches.

2. Non-Hormonal Treatments:

   • Tranexamic acid: This medication helps the blood clot more effectively, reducing blood flow by about 50%.

   • Anti-inflammatory painkillers (like ibuprofen) can reduce blood flow by about 25%, though they don’t affect how long your period lasts.

Surgical Treatments

If medications don’t work, there are surgical options to control bleeding:

1. Hysteroscopy: Polyps or small fibroids can be removed during this procedure.

2. Laparoscopy (Keyhole surgery) or Open Surgery: Larger fibroids that can’t be removed with a hysteroscopy can be treated using these methods.

3. Endometrial Ablation: This procedure destroys the lining of the uterus and is suitable if you don’t plan on having children. It’s usually done as a day procedure.

4. Hysterectomy: This surgery removes the uterus and is a permanent solution for heavy bleeding. It’s considered when other treatments haven’t worked or if it’s your preferred option.

When to Get Help

If your periods are affecting your daily life, causing you discomfort, or if you notice any of the red flags mentioned, it’s important to speak with your Gynaecologist. You can book an appointment with Dr Kohli to discuss concerns around heavy periods here