Heavy periods, or menorrhagia, are periods that are abnormally long and, above all, with a more sustained flow.
They can be identified by the formation of clots, and/or an overflow of blood from your sanitary protection. Heavy periods are considered abnormal when they exceed 80 ml of blood flow during the period.

How do I know if I have a heavy period?

I see you coming: but how can I measure 80 ml? Don’t panic 🙂
Practical: if you fill 1 to 2 sanitary towels in 2 hours or less, you are likely to have a heavy period. Another more graphic equivalent: 1/3 of a coffee cup, or 5 to 6 tablespoons (15 ml per spoon).
The first thing to know is that because it is a very subjective assessment, it is difficult for a woman to measure her blood flow during her period on her own.
To help you, there is a tool that allows you to better estimate the blood flow during your period thanks to your sanitary protection: it is the Higham score.

You fill in a table during your period with the sanitary pads’ number you use in a day, each pad used represents a number of points defined in the table. At the end of your cycle, you add all your points. If you get a result of more than 100, then you probably have a heavy period. However, don’t just rely on this score: if you have any doubts, the best thing to do is to consult your doctor/gynecologist.

What are the causes and symptoms of heavy periods?

The causes

There are many causes…

Heavy periods can be due to hormonal disorders: imbalance between estrogen and progesterone. Excess estrogen leads to an excessive growth of the lining of the uterus (endometrium) and contributes to the increase in the volume of the period.

The use of a copper IUD (intrauterine device), which can cause local inflammation in the uterine cavity

A blood clotting disorder

Benign tumors (polyps, fibroids, etc.) or adenomyosis.

More rarely a cancerous pathology

The symptoms

There are many symptoms.

The first signs are often periods lasting more than 7 days, with a heavy flow, and the presence of clots which may cause fatigue and/or pale skin. In the long term, heavy periods can lead to anemia due to iron deficiency.

Similarly, pelvic pain and pain during sexual intercourse (dyspareunia) may be experienced.

Difficulty in maintaining usual activities during menstruation and shortness of breath on exertion may also be secondary to heavy periods.

Can heavy periods be stopped?

You should be reassured that there is a solution to your problem.

The treatment must be adapted to the cause (functional bleeding (hormonal imbalance)) or organic bleeding (polyp, fibroid, etc.). After a medical consultation and possible additional examinations (a vaginal ultrasound and/or a diagnostic hysteroscopy, which consists, in consultation, of exploring the uterine cavity to look for an organic cause).

In case of hormonal disorders:

The first-line treatments are medical:

—If necessary, correction of anemia by prescription of a martial treatment;

—antifibrinolytics, which act on coagulation;

—Hormonal treatment with progesterone: either oral treatment (administered between the 16th and 25th day of the cycle, or between the 5th and 25th day of the cycle, or even continuously), or local treatment (progesterone IUD: Mirena® or Jayden® model);

—non-steroidal anti-inflammatory drugs such as ibuprofen (Advil®, Motrin®, Nurofen®), which reduce menstrual flow and alleviate associated pain.

If medical treatment fails, it is possible to consider conservative surgical treatment (i.e., keeping the uterus) by hysteroscopy on an outpatient basis.

Different techniques are possible:

-Either resection (surgical abrasion) of the endometrium (endometrectomy)

-Or destruction of the endometrium by introducing a balloon containing a liquid which is heated and destroys the endometrium (thermoregulation).

These surgical treatments cannot be offered if you wish to have children.

In case of organic lesions (polyps, fibroids, …), the lesion will be surgically removed. The surgical technique will be specified according to the nature, size, location and number of lesions.

As a last resort, for patients who no longer wish to become pregnant, radical surgical treatment (hysterectomy) may be discussed.

Scientifically validated by Pr Charles Chapron

Head of the Department of Obstetrics and Gynaecology II and Reproductive Medicine at the Cochin Hospital in Paris

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