Heavy Periods

The medical definition of heavy menstrual periods is the passage of more than 80 mL of blood each period. Because it is seldom practical to actually measure the blood loss, doctors rely on the patient’s description of her period. Periods are considered heavy when a woman bleeds for more than 7 days, when she passes clots, or has to use “double protection” (both tampons AND pads), and when she has to change her sanitary protection more frequently than 4 times a day. This degree of heavy bleeding will often affect a woman’s activities of daily living, such as work, sports, exercise, sexual intercourse, travel, and recreational activities.

In younger women, heavy periods are most often due to ovulation dysfunction, or failure of the ovaries to release the eggs in a monthly, cyclic fashion. In the years close to the menopause, heavy periods can also be a sign of hormone imbalance, or an underlying abnormality or disease. Conditions associated with heavy periods include fibroids, polyps and abnormal uterine bleeding (AUB), which refers to heavy bleeding with no apparent explanation.

Medical Treatment Options

If heavy or irregular periods interfere with a woman’s quality of life, she should see a gynecologist. A pelvic examination and ultrasound are often all that is needed to determine the cause of the AUB. A special pelvic ultrasound scan where a small amount of fluid is placed inside the uterus (sonohysterogram) is often helpful in diagnosis. An examination called a hysteroscopy may also be helpful. This involves placing a fine telescope through the neck of the womb so as to allow a direct visual inspection of the uterine cavity . If there are no visible abnormalities, treatment is not absolutely necessary – but desired by most women.

Abormal bleeding may be regulated by hormonal or non-hormonal treatment. Oral contraceptives (birth control pills), which contain the hormones estrogen and/or progesterone and are safe for longterm use, are often used to treat heavy periods due to ovulation dysfunction. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can also reduce monthly blood loss, and are most effective in combination with birth control pills. Alternative approaches also include the use of a hormone-containing intrauterine device, which is suitable for some women.

Surgical Treatment Options

Surgical treatment for heavy periods includes endometrial ablation, myomectomy, polyectomy, total vaginal hysterectomy (TVH) and total laparoscopic hysterectomy (TLH) or laparoscopic supracerival hysterectomy (LSH). Which treatment is best for the patient depends on the underlying cause(s) of the excessive bleeding as well as other considerations, including whether or not the patient wants to preserve their fertility and/or uterus. At the Georgia Advanced Surgery Center, these minimally invasive procedures are performed as same-day, outpatient surgeries that require no unsightly incisions or hospitals stays, and provide patients far faster and less painful recovery than traditional surgery.