Q&A with Dr Andrew Paterson, Consultant Gynaecologist at BMI Ross Hall Hospital

How much is ‘heavy’ when it comes to blood loss?

This is subjective. Heavy for one woman may be normal for another. Heavy menstrual bleeding can have a major impact on your quality of life, so any intervention aims to improve this. 

Most women will lose less than 16 teaspoons of blood (80ml) during their period, with the average being around six to eight teaspoons.  Menorrhagia (Heavy menstrual bleeding) is defined as losing 80ml or more in each period, having periods that last longer than seven days, or both. 

Most women have a good idea of how much bleeding is normal for them during their period and more importantly - can tell when this changes.

A period is heavy is if you: are having to change your sanitary products every hour or two; are passing blood clots larger that a 10p coin; are bleeding through to clothes or bedding; or often need to use tampons and pads together.

What causes heavy periods?

More than half of women with heavy periods will have no identifiable cause – this is called Dysfunctinal Uterine Bleeding. However, some of the identifiable causes are structural (such as polyps in the cavity of the womb or fibroids enlarging and distorting the cavity of the womb); medical (such as over or underactive thyroid or blood clotting disorders); prescription treatments (such as warfarin or the copper contraceptive coil). On very rare occasions there may be a more serious illness such as cervical or endometrial cancer.

What happens during diagnosis and treatment?

After discovering a full history, a full blood count is taken to check for anaemia. Thyroid tests will be done along with a pelvic examination including a smear test.

What further investigations can be done?

You may have an ultrasound scan and be given a hysteroscopy in which a sample from the lining of the womb is analysed.

What are the treatment options?

This depends on your age, your desire either for contraception or to have a baby. You may be given non-steroidal pain killers such as mefaminic acid or naproxen which will reduce pain and block the prostaglandins that regulate blood vessels in the womb.

You may be given tranexamic acid four times a day for four days to alter menstrual blood clotting. Progesterones such as norethisterone can be taken for up to 21 days to reduce or postpone periods, which is useful if, for instance, you are about to go on holiday. Contraceptive pills may also be used, and in some cases an intrauterine progesterone might be applied, a highly effective treatment which puts hormones directly in the cavity of the womb. Most women find this stops their period completely.

Surgical interventions

There are some minor procedures such as endometrial ablation in which the lining of the womb is removed. This is effective but also means any future pregnancies are ruled out.

Fibroids can be treated with transcervical resection which removes the distortion caused by the fibroid; or embolisation – blocking the fibroid’s blood supply - or a myomectomy which removes the whole fibroid. A hysterectomy is also an option.

Why choose BMI Ross Hall Hospital for treatment?

1. Appointment times to suit your schedule, usually available within 48 hours.

2. No waiting lists.

3. Fixed price packages with no hidden costs.

For more information

Fill out an enquiry form, email enquiries.rosshall@bmihealthcare.co.uk or call 0141 303 1405.