Heavy periods are a common presenting complaint and are associated with painful periods (dysmenorrhoea). The commonest causes of heavy periods (menorrhagia) are: uterine fibroids, ovarian cysts, endometriosis and adenomyosis, hormonal imbalances such as polycystic ovaries, endometrial polyps, medical disorders, pelvic infection and problems with contraception.
This is a relatively common condition in which the uterine lining (endometrium) grows outside of the uterus, often on the fallopian tubes and ovaries. Endometriosis causes pain because the tissue will grow in the same way as the tissue in the uterus and will bleed when the woman has her period, but because it is outside the uterus, it has no means of escape and causes pelvic pain, inflammation and scar tissue and adhesions that make the insides stick together. If the endometrial tissue grows on the ovaries and it bleeds, this can cause painful cysts.
Endometriosis can be removed via laparoscopic surgery.
Uterine fibroids are benign (non-cancerous) growths in the uterus. They are very common. In many cases they are small and don’t cause symptoms but if they grow larger they can cause pain and heavy periods. This may be because they prevent the uterus from contracting effectively during menstruation, resulting in a heavier blood loss. It could also be because they are perceived as a ‘foreign body’ so the uterus attempts to expel them by squeezing them out and this causes longer periods, more bleeding and bleeding in-between periods.
Fibroids can be removed by laparoscopic or open abdominal surgery.
Ovarian cysts don’t usually cause symptoms but if they grow very large, they block the blood supply to the ovaries or they rupture (split) they can be very painful. When this happens, the woman may have heavy periods or irregular periods with pelvic pain which may feel like period pain or be severe, sharp and ‘stabbing’. They might also have difficulty having a bowel movement or pain when urinating. Any severe or sudden pelvic pain may be an emergency and should be investigated at hospital.
Polycystic ovarian syndrome occurs when lots of cysts grow on the ovaries. This can cause enlarged ovaries, pelvic pain and prolonged menstruation. The contraceptive pill is sometimes used to lighten and regulate periods in women who are suited to the pill.
Polyps are benign (non-cancerous) growths in the uterine lining or at the cervix. They can be numerous. They cause heavy or prolonged menstrual bleeding, bleeding in between periods and bleeding after sexual intercourse. They can be removed by hysteroscopy – a thin telescope in inserted into the vagina and through the cervix and then instruments are passed down the scope to remove the polyps.
Adenomyosis is similar to endometriosis. Endometrial tissue which usually just lines the uterus, instead grows deeper into the muscular wall. Despite this, it still grows, breaks down and bleeds like normal uterine tissue, causing a painful and swollen uterus and heavier periods. As the problem usually corrects itself after menopause, medication is the preferred way to manage the condition, although hysterectomy may be an option to women who don’t want to have anymore children.
Deficiency in thyroid hormone can cause heavy periods, very frequent periods or short cycles between periods. This hormonal imbalance is also associated with painful periods, nausea and menstrual headaches. It is treated with thyroid hormone replacement therapy.
Sexually transmitted infections like Chlamydia often have few symptoms but may cause heavy periods and pelvic pain. They are treated with antibiotics.
A copper intra-uterine device (IUD) for contraception may cause excessive menstrual bleeding and bleeding in between periods. Switching to an intra-uterine system (IUS) that releases hormones may help.