Heavy Menstrual Bleeding
What is a ‘heavy period’?
If a woman need to change her tampon or menstrual pad after less than 2 hours or she has noticing passage of blood clots, the size of a 50 pence or larger, then, it considered as heavy bleeding.
“Heavy period also means that her period lasts longer than seven days or that she loses more blood than is typical during periods.
Woman may bleed so much that she has to change her tampon or pad every hour for several hours back-to-back. Menstrual bleeding that’s so heavy that it interferes with her daily life is never normal (1).
What are the ill effects of heavy menstrual bleeding?
Untreated heavy or prolonged bleeding can stop a woman from living her life to the fullest. It also can cause anaemia. Anaemia is a common blood problem that can leave woman feeling weak and tired, loss of hair, can’t concentrate on her job and social embarrassment. With heavy periods, some women can’t maintain their usual activities when they have their period because they dread unscheduled heavy blood loss and cramping. This can affect her mood and cause psychological disturbance
What medications can be used to ease the symptoms of heavy periods?
There are several different medication options available to help women with heavy periods. Please note that medication option is not for everywoman with heavy periods. It is important that the affected woman has the opportunity to discuss her problems with her doctor and explore which choice is most suitable for her
There are mainly two varieties, non-hormonal and hormonal. It is usually best to try a suitable treatment option with the smallest associated risk initially.
When it comes to non-hormonal option, the woman’s cycles need to be regular and heavy.
If she is considering a pregnancy and suffers from heavy periods, then tablets such
as Tranexamic Acid and Mefenamic Acid taken during a period may be helpful in reducing the amount of bleeding.
Tranexamic acid is particularly useful in women who either desire immediate pregnancy or for whom hormonal treatment is not desirable.
Tranexamic acid is a well-tolerated drug. Tranexamic acid works by slowing down blood clot breakdown. When taken in isolation,available evidence indicates that tranexamic acid can cause reduction of 30–50 % menstrual blood loss (2)
Mefenamic Acid is a non-steroidal anti-inflammatory drug (NSAID) which blocks the production of certain chemical messengers (prostaglandins) that cause menstrual pain and heavy bleeding. It reduces blood loss by 30–50%
Taken together, i.e., Tranexamic acid and mefenamic acid, reduce blood loss between 60 to 80%
However, if a woman’s cycles are not regular, these tablets will not help to change the pattern of bleeding
Hormonal options include – simple combined birth control pills ( if not contraindicated) will reduce blood loss by 50%. Qlaira, a new combined oral contraceptive pill containing the ‘natural’ oestrogen estradiol valerate and the progestogen dienogest, has recently been licensed for use in women with heavy menstrual bleeding. The main advantages of Qlaira are the lower intensity and shorter duration of withdrawal bleeds.
Levonorgestrel-releasing Intra-uterine System (LNG-IUS, eg Mirena or Levosert). This is a small T-shaped device is inserted inside the womb and is often the first hormonal option for treatment of heavy periods, as it has been shown to be the most effective medical treatment and improves quality of life. Levonorgestrel intrauterine system significantly reduces the burden of menstrual blood loss from baseline as early as three cycles. It causes significant reduction in menstrual blood loss by 80% in 3 cycles and >90% by six cycles (3)
It delivers a long-acting progesterone to the lining of the womb to thin it. There is
very little hormone delivered to the rest of the body. It can last for 5 – 8 years and it is suitable for most women. The main side effect is irregular breakthrough bleeding which usually settles down in the first few months. It provides effective contraceptive cover if this is needed
Oral Progesterone
These are progesterone-like tablets which are usually taken daily. They can work well in the short term to stop a heavy bleed. However, bleeding can often start
again when the tablets are stopped. It can be used to regulate bleeding for up to three months but it is not usually a suitable long term option.
GnRH Agonists (eg Prostap or Zoladex): These are hormonal injections which work to suppress the ovaries and halt the menstrual cycle. They can be effective for some women, especially those with large fibroids or those not suitable for other forms of treatment. They are usually only given for a course of six months treatment. Their main side effects are due to causing a temporary menopause.
Can certain medications or vaccines cause heavy periods?
The medications which are associated with heavy menstrual bleeding are,
Anticoagulants /blood thinners (non-steroidal anti-inflammatory drugs, aspirin, warfarin and heparin), Antidepressants, Antipsychotics, Corticosteroids, Herbs such as ginseng, chasteberry and Tamoxifen
Vaccines are also associated with heavy periods especially after having Covid vaccine , vaccine-induced thrombocytopenia may be an explanation for the recent incidences of heavy menstrual bleeding experienced by women in different countries after the CoViD-19 vaccination (4)
Reference
1. ( Ref – https://www.cdc.gov/ncbddd/blooddisorders/women/menorrhagia.html)
2. ( Ref – https://doi.org/10.1111/j.1600-0412.2012.01361.x)
3. ( Ref – Reid C. and Virtanen-Kari S. BJOB 2005; 112:1121-1125)
