Heavy Periods

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Heavy and/or painful periods are common in the years after they start and in the years leading

up to menopause. These bad periods can be painful or painless. They can also be very

irregular, or come very frequently. There may be spot-bleeding in between the bad periods.

Often there are clots passed. These clots can vary from small to very large.

Flooding can also occur as well as clots. Flooding occurs when there is too much blood to even clot

properly and is a sign of very heavy bleeding. This often leads to frequent changes of pads and tampons

and the need to use two types of protection at once. Tiredness, weakness, light-headedness and anaemia are 

more likely when clots are passed, or flooding occurs.

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What are the causes ?

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A variety of things can cause periods to be heavy and/or irregular.

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• Dysfunctional uterine bleeding or Hormonal Imbalance. Non-specific cause of abnormal bleeding. Common when the periods start, and leading up to the menopause. Probably related to subtle hormonal changes.

• Fibroids –  benign growths in the wall of the womb.

• Endometrial polyps – benign growths in the lining of the womb.

• Adenomyosis (endometriosis in the wall of the womb).

• Abnormal hormonal stimulation eg. polycystic ovarian syndrome (PCOS) or thyroid problems.

• Endometrial hyperplasia – overgrowth of the lining which can lead to….…Cancer of the uterus.

• Use of blood thinners such as warfarin, or women with von Willebrand’s disease.

• Infection of the cervix or uterus.

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These are just a few of the problems that can cause abnormal uterine bleeding. These problems can occur at any age, but the likely cause of abnormal uterine bleeding usually depends on your age.

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How is a Diagnoses made?

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• An examination.

• An internal (transvaginal) pelvic ultrasound can be helpful but doesn’t always detect subtle causes of bleeding, for instance small endometrial polyps. Dr Swanepoel is an accredited ultrasound provider and this examination can be performed at your visit and will be Bulk Billed.

• A biopsy of the lining of the uterus, to check for cancer.

• Swabs for infections eg. Chlamydia etc.

• Hysteroscopy – looking directly into the womb with a telescope, and then taking biopsies, or removing the cause of any bleeding, like fibroids or polyps. This will be performed as a day case in hospital with quick recovery.

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What are the Treatment Options?

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There are several treatment options for abnormal bleeding. Your treatment will depend on the cause of your bleeding, your age, and whether you want to get pregnant in the future.

A stepwise approach will always be advised, starting with:

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• Medical therapy​​

  • Iron to replenish iron stores. (Tablets, injections or Iron Infusion).

  • Nonsteroidal anti inflammatory drugs (NSAIDs) like Ponstan or ibuprofen may reduce bleeding & pain.

  • The pill may reduce & regulate periods.

  • Progesterone tablets may regulate the periods (they don’t reduce the amount lost).

  • Tranexamic acid (Cyklocapron) – can reduce very heavy bleeding by 20-30 %.

• Mirena

  • Mirena is a device that is placed in the womb for up to 5 years. It releases a small dose of hormone which “turns off” the womb lining. It’s very safe, and is also an excellent contraceptive. The main drawback is irregular bleeding for the first few months – this usually settles. 80% of women are happy with the method.

• Hysteroscopy, polypectomy & curettage, or removal of fibroids

  • – Suitable for those with endometrial polyps or submucosal fibroids. Mirena or an ablation can be done at the same time.

• Endometrial ablation

  • Endometrial ablation is where we remove the lining of the womb just after doing a hysteroscopy. An ablation is irreversible. 40 % of women will not have a period again after an ablation while of the remaining 60 % of women, 80% noticed a reduction in the heaviness of their periods. Recovery is usually rapid (1 week), complications are unusual, and satisfaction high (80%) and most women go home the same day. You still need to think about contraception, so it’s good for women who have been sterilised or who have partners with a vasectomy. If you would prefer, we can always do a sterilisation by keyhole surgery at the same time as the ablation.

• Myomectomy

  • Suitable for those with fibroids who wants to conserve fertility.​

• Hysterectomy​​

  • A permanent 100% no further bleeding solution.

  • Keyhole Hysterectomy would almost always be recommended due to its quick recovery, minimal pain and blood-loss and other benefits. Not everyone will be suitable for each type of hysterectomy and Dr Swanepoel will advise you on which hysterectomy is most suitable for your situation.  

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Painful Periods

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While some women experience minimal or mild discomfort during menstruation, other women suffer from severe, debilitating pain that prevents them from doing their day to day activities. Some women may have always experienced painful periods, others may develop pain. Period pain is more common in adolescents and women in their 20s, but can also occur in older women.

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What causes painful periods?

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Period pain happens when the muscles in the uterus

contract or tighten. Pain may include cramping and
heaviness in the pelvic area, as well as pain in the

lower back, stomach or even legs. Some women
also experience nausea, vomiting, paleness, diarrhoea

or loose bowels. Women who experience painful periods

may have higher levels of prostaglandins – a natural

body chemical that causes contractions of the uterus,

bowel and blood vessels.

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Painful periods can be due to:

• Pain in the uterine (womb) muscle (myometrium)

      especially if the pain is on the first one or two days of a

      period.

• Pain from endometriosis and/or adenomyosis, especially

      if the pain is there for more than one to two days before

      the period starts.

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What are the treatment Options?

• Heat pack.

• Pain relief (Anti-inflammatories like Ponstan).

• Oral contraceptive pill (OCP).

• Mirena® intrauterine device. 

• Endometriosis may be treated using keyhole surgery.

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