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Why is my period so heavy?

Why is my period so heavy?

Many women experience heavy bleeding, and many of those women accept it as normal. But if you're in pain, you have options

Excruciating pain, dizziness and fainting, low iron levels and anemia, reduced immunity, migraines, nausea and fatigue are symptoms reported by sufferers of heavy menstrual bleeding (HMB) also known as menorrhagia.

More than one in five women live with heavy periods and the associated effects but only 50 per cent of sufferers consult their GP about the issue, highlighting that some women still consider heavy periods as something they just have to put up with. A survey carried out by Wear White Again reported that 62 per cent of women with HMB did not realise heavy periods are a medical condition. 

With frequent, major disruptions to everyday life, sufferers have a significantly decreased quality of life resulting in physical symptoms being accompanied by emotional distress, reduced confidence, anxiety and depression. 

Of the women seeking medical advice for HMB between 40—60 per cent are found to have no underlying health issues causing the bleeding after investigation—such as fibroids, or endometriosis.  

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What’s the difference between a heavy and a normal period? 

Heavy menstrual bleeding is medically defined as losing 80ml or more in each period, and passing blood clots larger than 2.5cm. A more tangible measure is having to change pads or tampons very frequently such as every hour or two and experiencing flooding, where blood seeps through all sanitary protection and through clothes, as well as changing pads or tampons during the night.  

Revised NICE guidelines on heavy menstrual bleeding were published in March 2018 with a shift in focus away from quantity of blood loss and towards the impact on a women’s quality of life.  

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Diagnosis and treatment 

Amanda*, 39 had controlled her heavy periods with the pill from the age of 20, but they returned with a vengeance when trying to conceive at the age of 34 and again six weeks after the birth of her second child but also became incredibly painful.  

‘’My first six periods after Zac felt like miscarriages they were so painful—and soaking through sanitary pads and tampons super quickly’’ she says. After constantly leaking through her clothes at work, causing huge embarrassment, as well as suffering from acute pain, she returned to her GP several times to try and address the issue: ‘’I wasn’t taken very seriously and was told, ‘periods are just heavier at your age’’’ she continues. 

An audit by the Royal College of Obstetricians and Gynaecologists on HMB found out of the one in five women who visited their GP for HMB almost half of these women had three or more visits to the GP regarding HMB prior to referral to secondary care.  

Amanda was prescribed the Mirena IUD, a contraceptive device that also treats heavy periods.   

Hormonal treatments used to treat heavy periods include oral contraceptives as well as IUDs. Other treatments include medication (tranexamic acid and NSAID) or surgery (endometrial ablation or hysterectomy).

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The hidden cost of heavy periods 

It is estimated that 5 million work days are lost each year in the UK due to menstrual problems, resulting in a huge socio-economic cost.  

There is still an air of taboo around periods—especially in the workplace. Calling in sick to work because of a period still carries with it stigma, with sufferers facing varying degrees of support and understanding.  

Many women do not feel comfortable telling their employers about their health condition. Megan who currently works for herself is unable to work for two days a month due to her period and schedules her work around these days. In a previous job she took sick leave due to her heavy period but never used it as the reason when telling her manager.  

‘’It feels like it wouldn’t be considered a good enough reason to take time off. It’s just not something you say and it’s also a private issue I didn’t feel comfortable telling my boss about.’’ she says.  

As well as time off work over 60 per cent of women report having had to miss social or athletic events. 

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The future 

It is clear there are still steps to be taken to develop new treatments, raise awareness, improve understanding and abolish stigma around HMB.  

Co-exist, a community interest firm in Bristol was the first UK-based company to introduce a menstrual leave policy in 2016. Perhaps this will be the norm for workplace policies in the future, to allow those who are suffering with HMB access to paid or unpaid leave. 

Recent research from the University of Edinburgh, funded by Wellbeing of Women, discovered women with heavy periods typically had lower levels of a protein (HIF-1) compared to women with a lighter flow. Production of the HIF-1 protein speeds up the healing process of the womb lining (endometrium). When the endometrium is shed, this causes a woman to bleed during her period. Therefore, creating a treatment for women with heavy periods that boosts their levels of HIF-1 could lead to an effective new treatment. 

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