How do you know that your periods are abnormally heavy?

1. Soaking of one or more sanitary pads or tampons every hour
2. Passing blood clots
3. Need to flow double menstrual pads to control the flow
4. You need to wake up at night to change your pad
5. Menstrual flow lasts for more than 7 days
6. You might develop anaemia or low Haemoglobin levels due to heavy flow which can cause fatigue, weakness and breathlessness or at times swelling over your face and legs

What causes heavy periods?

• Hormonal imbalance:Conditions that cause hormone imbalance are hypothyroidism, PCOS or polycystic ovaries, Obesity, etc. Due to hormone imbalance ovulation might be affected which can lead increased thickness of the inner layer of the uterus called endometrium. This causes heavy menses
• Uterine Fibroids:These are benign tumors or growths of the uterine muscle. Uterine fibroids may cause heavier than normal or prolonged menstrual bleeding. They can also cause painful periods.
• Polyps:These are small, benign growths arising from the inner lining of the uterus.
• Adenomyosis:In this condition endometrium or inner lining of the uterus grows inside the uterine muscle. This condition can cause heavy and painful periods.
• Inherited bleeding disorders:Defects in the clotting system of the body can also lead to heavy periods.
• Other medical conditions:Cancer of the cervix and the uterus can also cause heavy periods. Uterine cancer is usually seen in post-menopausal women

Complications

Excessive or prolonged menstrual bleeding can lead to other medical conditions, including:

• Anemia. Iron deficiency anemia occurs if the woman has prolonged and heavy periods. Signs and symptoms include pale skin, weakness and fatigue. Although diet plays a role in iron deficiency anemia, the problem is complicated by heavy menstrual periods.

Tests done

• Consult a gynaecologist when you experience heavy and prolonged periods.
• Such conditions may or may not be associated with Pain
• Need to get routine hormone assays like thyroid and hormone assays to rule of PCOS
• Routine pelvic ultrasound to rule out fibroids, polyps and adenomyosis
• Haemoglobin and other blood tests to rule out clotting issues

Treatment

Depends upon the diagnosis

• If any hormonal imbalance is detected. Correcting hormone imbalance will help stop the heavy periods
• Most Women might need hormone therapy to control heavy flow
• Intrauterine devices (hormonal IUD) which release progesterone makes the uterine lining thin and decreases menstrual blood flow and cramping.
• Small fibroids do not need surgery
• Adenomyosis can be treated with medication
• Weight management in cases of PCOS and Obesity
• Correction of anaemia with medications and iron injections if needed

When is surgery needed?

• If medication does not help in controlling the flow, D & C procedure is done and endometrial sample is collected for biopsy. This might be done along with hysteroscopy which is examination of the inside of the uterus with help of an endoscope
• Myomectomy or removal of fibroids which are more than 4-5cm in size and are inside the uterine cavity (submucous) or the uterine musculature (intramural). Fibriods that are outside the uterine wall also called as subserous fibriods usually do not cause heavy flow even if they are big and many times do not need surgery. Fibriods can also be treated with uterine artery embolisation
• Extreme cases when other treatments fail might need removal of uterus or hysterectomy.