Heavy periods

Menstrual flow can vary a lot from one woman to another, and can also change over time during a woman’s reproductive years.

Light periods aren’t usually a concern unless they are in combination with absent or infrequent periods. Heavy periods, however, can be an issue. Frequent pad changes, large clots and having accidents or overflows may indicate excessive bleeding.

“It can interfere with quality of life,” says Dr. Yolanda Kirkham, a gynecologist at Women’s College Hospital. “If women are having accidents at work or school, or if they need to miss work or school because of excessive bleeding or pain, they should see their doctor.

“Heavy periods can also cause symptoms of anemia,” she adds. Anemia is a condition in which there aren’t enough red blood cells in the blood, or those cells don’t have enough hemoglobin. “As a start, people can include more iron in their diets – things like red meat and dark greens – because iron is the building block of our blood cells.”

Symptoms of anemia include:

• feeling lightheaded
• shortness of breath
• fatigue
• trouble concentrating

Factors that can lead to heavy periods include hormonal causes, structural issues and bleeding disorders such as von Willebrand disease.

In very young women and women who are perimenopausal (approaching menopause), heavy periods often have a hormonal cause. Anovulatory cycles – cycles in which a woman does not release a monthly egg – can cause heavy menstrual bleeding.

“At the young end of the spectrum, it takes two to three years from the time of the first period for ovulation to become more regular, as the body is learning to release those hormones to communicate with the ovary,” Dr. Kirkham explains.

“Whereas in the perimenopause, those cycles are also becoming anovulatory because the hormones from the ovary are decreasing and the ovarian reserve is decreasing.”

Treatment for heavy periods targets the cause, Dr. Kirkham says. If the cause is hormonal, birth control pills and other hormonal contraceptives are often used to prevent heavy bleeding.

Another cause of heavy periods in perimenopausal women is bleeding disorders, because women in this age group are more likely to be taking blood-thinning medication for other health issues.

For women in between those age groups, in their 30s and 40s, structural factors such as polyps, fibroids or adenomyosis may be the cause of heavy periods. An ultrasound is helpful in diagnosing these conditions. Structural issues are treated with medication or surgery or both.

“Treatments include hormonal and nonhormonal medications, and the hormonal (progesterone) IUD,” Dr. Kirkham says. “And in these cases, surgical treatment may be the best management, in addition to medical treatment.”

An endometrial biopsy may also be done to ensure there is not any abnormal thickening of the uterus or uterine cancer in older age groups. Dr. Kirkham adds that exercise and good nutrition can help reduce the risk of endometrial cancer, which is associated with obesity.

After menopause, any vaginal bleeding is considered abnormal and should be investigated. Menopause begins one year after a woman’s last period. So it’s recommended that any bleeding in a woman who has not had a period for over a year be examined.