Menstrual disorders - heavy or prolonged periods

11 August 2021

Read time: 4mins

Do you have heavy or prolonged periods? Menstrual disorders explained.

dr iris wang

Written by

Dr Iris Wang

Fertility Specialist, IVFAustralia

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Have you ever thought to yourself that your heavy periods are impacting your day-to-day life?

During your period, do you need to constantly change pads and/or tampons every hour? Or maybe you have extra-long periods that last more than seven days?

You might have a menstrual disorder called ‘menorrhagia’.

In our ‘Let’s Talk about Periods’ series, we’ll be discussing the common menstrual disorders and what they mean for a woman’s fertility potential. 

This week’s topic is one that’s important to discuss due to the significant impact is has on the lives of women who experience it.  It is also a common issue. One in five women bleed so heavily during their menstrual cycle that they have to put their normal lives on hold each time their period comes.

So what is Menorrhagia exactly?

Simply put, menorrhagia means excessive bleeding with periods.  The strict definition is total blood loss greater than 80mls or bleeding for over 7 days. In reality, of course, no one will actually measure blood loss in usual day-to-day setting.  Common symptoms of menorrhagia include:

  • Passing big clots commonly and consistently during periods
  • Changing pads/tampons every 1-2 hours during the heavier days
  • Getting up at night to change the pads
  • Using maternity pads or a towel at night for fear of staining
  • Equally, using both a pad and a tampon concurrently to avoid “accidents”

 

Due to the heavy bleeding, many women may experience a lack of energy and tiredness alongside their heavy monthly flow. This can be a real struggle for women trying to juggle their busy everyday lives.

- Dr Iris Wang

There’s also a potential for heavy periods to result in an iron deficiency or even anaemia, so it’s important to see your doctor if you’re noticing a significant lack of energy together with heavy periods.

You don’t have to just ‘deal with it’.

There are medical treatments available to slow or even stop blood flow, such as taking the oral contraceptive pill, antifibrinolytic or anti-inflammatory drugs. Hormone loaded IUD can also reduce blood flow significantly.

A surgical procedure called hysteroscopy or D&C, may be required to clarify the diagnosis.

Surgical treatment to remove fibroids and restore uterine anatomy, which can be the cause of heavy bleeding, is the treatment of choice for some afflicted with menorrhagia caused by fibroids.

What does it mean for your fertility?

This is a complex question to answer. Whether or not menorrhagia affects your fertility depends on the cause of it in the first place, which, unfortunately, can be difficult to find.

The cause of heavy menstrual bleeding can vary, from:

  • Hormonal imbalances such as PCOS
  • Structural abnormalities such as fibroids, endometriosis or polyps
  • Medical conditions

Hormonal imbalances can play a huge part in a woman’s ability to conceive. You may have heard of progesterone and estrogen, which are key players in your fertility potential. Hormonal imbalance related to anovulation may lead to irregular and sometimes very heavy periods.

Conditions such as PCOS can be the culprit here. But the good news is that there are fertility treatments in the form of oral medication that can help overcome hormonal imbalance and increase your chance of pregnancy.

When it comes to structural abnormalities such as fibroids, they are actually very common amongst women but rarely require surgical intervention except if they are causing debilitating menorrhagia or are rapidly expanding in size.

Fibroids usually do not cause any fertility issues except when they are located inwards, distorting the uterine cavity. These are called submucous fibroids, and they can distort the anatomy of the uterine lining and may affect implantation and increase the risk of miscarriages. This is where surgery to remove the fibroids can be beneficial for women hoping to conceive.

Other structural abnormalities such as endometriosis or polyps can affect your fertility, and surgery may be required to treat it. Endometriosis is another complex issue, which you can read about here. When fertility desire is the primary goal, surgery for endometriosis is usually not recommended unless there is debilitating pain or large endometriotic cysts (also called endometriomas) on ovaries.  Instead, treatment is directed at the management of infertility.

Medical conditions or systemic illness such as thyroid problems, blood clotting disorders, or rarely leukemia may also be the cause of menorrhagia. If this is the case, your fertility specialist can discuss your individual circumstances and arrange appropriate medical referral.

What next?

The important thing to take away from this, is that you should absolutely see your doctor if your periods are having a significant strain on your day-to-day life. Not only so that your doctor can help you overcome excessive bleeding by exploring treatment options to improve your quality of life, but also so that you can begin a discussion about your fertility early and explore not only the treatment of menorrhagia but also your fertility options.

The absence of periods, or amenorrhoea

In the previous article in this series, we discussed the absence of periods, otherwise known as amenorrhoea. Read the article below.

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