How to handle heavy periods

We’re all unique when it comes to periods, and it can feel like sometimes no two periods are the same. 

Here’s a quick guide on what is normal, what isn’t, and what can be done about it.

What is a normal period?

While periods are different for everyone, an average period lasts 28 days +/- 3 days. It is the most variable under the age of 25, and the most stable in our mid- to late- 30s. Our period then starts to lengthen out over the age of 40.

It looks like a lot of blood is lost, but in reality, for the majority of us, we only lose around 1-5 teaspoons of blood.

The remainder of our flow is vaginal fluid and tissue from the lining of the womb.

The bleeding might start off light-ish, then becomes heavier for a few days, then generally stops at around 5 days.

Some women get minor period cramps that generally only need some basic painkillers or a hot water bottle and don’t stop daily life and work.

How do I know if my periods are heavy?

Only you will know if your period is abnormal. As soon as your period is impacting on your physical or mental health, or it is interfering with your life, then it isn’t normal.

Generally speaking, if you’re passing clots, flooding through your period protection onto your clothes or bed sheets, needing to change your pad or tampon every hour, or can’t leave the house due to severe pain and bleeding, then you need to seek advice from a healthcare professional.

The bottom line is, your period is a problem if you’re not coping with it. Some women discover that they are only abnormal once they find out they are anaemic (low iron levels in the blood), suggesting heavier than average flow. 

We don’t need periods!

Did you know that we don’t actually need a period? Yes, it is a sign that everything is well, but we don’t need the monthly reminder.

Think about it from a historical perspective. 

Having a period was a sign a woman was ready to start getting pregnant. Once she was married, the hope would be that she would soon have a baby.

After pregnancy, if she was aristocratic, a wet-nurse would feed her baby so she could get back to making more babies again. If she was lucky, she wouldn’t have many periods before being pregnant once more. 

If she wasn’t aristocratic, she would breastfeed her baby to weaning (having no periods all the way through), and then without contraception, would likely fall pregnant again when she stopped, or would have missed periods due to low body weight caused by hard physical work and poor nutrition.

And on and on this cycle would go until she either died in childbirth or died of something else. Very rarely would a woman make it through menopause and beyond.

Not having a period isn’t unhealthy. The blood doesn’t build up somewhere or stop toxins escaping the body. The bleeding comes from the lining of the womb shedding when there isn’t a fertilised egg to keep it intact. This is controlled by changing hormones. The lining regenerates every month unless there is something stopping it from doing that.

The cause could be deliberate through medication use, or it might be caused by a health condition such as hyperthyroidism, PCOS (polycystic ovary syndrome) or low body weight, so it is important to establish a cause if periods spontaneously stop.

What treatments are there for heavy periods?

Non-hormonal

These medications don’t help to reduce bleeding long term. They are for short term use during each period.

Anti-inflammatories

These include medications like ibuprofen, naproxen and mefenamic acid. While they aren’t designed to help with bleeding, some women find them helpful, particularly for pain relief. Not everyone is safe to use these medications though, so before you reach for them, check with a pharmacist.

Antifibrinolytics

Tranexamic acid is helpful for some women to control bleeding. It is used in various forms across medical practice and has a particular use in heavy periods. It is used for the first 4 days of every period to reduce the flow of the bleeding.

Hormonal

Hormonal contraception can be extremely helpful for controlling bleeding, even if you don’t need it for pregnancy control. None of them are perfect though, but here’s a quick rundown. If you want to learn more, or even speak to a doctor to discuss your best hormonal option, why not book in with a doctor (including me!) on the women’s health review site, The Lowdown?

Combined Contraception

Combined pills, patches and rings contain synthetic hormones based on oestrogen and progestogen which we need for a regular menstrual cycle. The idea behind these methods is that they “take over” your natural cycle and put you into a more manageable, but artificial one. You don’t have to have a period break on them and it’s possible to take them back to back so you miss out on as many periods as possible. Like with anti-inflammatories, not everyone is safe to take combined  contraception (COCs), so always check with a healthcare professional about what is right for your personal circumstances.

Progestogen Only Contraception

These are similar to COCs but only contain progestogen, a synthetic progesterone. Each method has a slightly different progestogen and they each have their own properties. It’s definitely not one size fits all! They come in pills, injections, implants (a plastic rod put into the arm which is about the size of a matchstick) and hormonal coils (a t-shape device inserted into the womb). They can be highly effective at reducing, and even in many cases, stop bleeding completely. 

Surgical

If all of the above methods fail, or aren’t suitable, then it falls to surgery to help. For this, you will need to be referred to a gynaecologist who can do procedures to stop bleeding. You will also need to make sure you don’t want children, or any more children because these procedures cause infertility.

Endometrial ablation

This procedure heats up the lining of your womb so that it stops regenerating. It is an effective treatment! 82-97% of people who undergo an ablation notice a favourable change in their bleeding with 85-98% satisfied with the outcome. However, after 5 years, up to 16% of people will need another operation for recurrent or persistent bleeding.

Hysterectomy

The final option is to have your womb removed, either partially (with cervix left behind), or totally. In either case, the ovaries can also be removed, but it will require hormone replacement therapy to stop the negative consequences of a sudden drop in hormones caused by a surgical menopause. 

Final thoughts 

We don’t need periods, but it’s nice to know if it’s normal or not. If you’re struggling with your monthly bleeds, then maybe you need to speak to a healthcare professional about what is going on.

If you want to talk to a female women’s health doctor about your periods, get on the waiting list for The Female Health Doctor Clinic opening soon!

Until next time,

Dr Nikki x

Sources

1. Chiazze, L., Brayer, F.T., Macisco, J.J., Parker, M.P., Duffy, B.J. (1968). The Length and Variability of the Human Menstrual Cycle. JAMA; 203(6): 377–380.
2. NHS; Periods: https://www.nhs.uk/conditions/periods/ 
3. Heyi Yang, Bo Zhou, Mechthild Prinz, and Donald Siegel (2012) Proteomic Analysis of Menstrual Blood: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494145/ Mol Cell Proteomics. Oct; 11(10): 1024–1035
4. The Lady in Red: Medieval Menstruation https://onthetudortrail.com/Blog/2015/02/10/the-lady-in-red-medieval-menstruation/#:~:text=To%20start%2C%20medieval,than%20today%E2%80%99s%20females 
5. Magdalena Bofill Rodriguez, Anne Lethaby, Cindy Farquhar; Non‐steroidal anti‐inflammatory drugs for heavy menstrual bleeding: Cochrane Database Syst Rev. 2019; 2019(9): CD000400
6. FSRH – taking combined contraception continuously: https://www.fsrh.org/blogs/contraception-mythbusters-it-is-not-safe-to-take-coc/ 
7. Nicole Minalt; Christinne D. Canela; Sarah Marino (2022); Endometrial Ablation: https://www.ncbi.nlm.nih.gov/books/NBK459245/ 
8. BUPA; Hysterectomy: https://www.bupa.co.uk/health-information/womens-health/hysterectomy