Heavy periods, also called menorrhagia, affect one in five women and have a considerable impact on their health. The point with two gynecologists, Pr Hervé Fernandez (Kremlin Bicêtre) and Dr Vincent Villefranque (Eaubonne Montmorency).
Definition: how to recognize heavy periods?
We are talking about heavy periods according to several signs:
- When the bleeding last more than seven days per month ;
- When they are very abundant, even if they last less than seven days;
- In case of bleeding during the cycle, which is added to the menstrual bleeding.
Heavy periods require a more frequent change of sanitary protection during normal periods, more than every 4 to 5 hours. Some women affected by heavy periods sometimes have to double their protections and change them every two hours or even wake up at night to have to change them.
“We know that the heavy periods affect about 20% of women. If heavy bleeding is the first reason for consultation in gynecology among women between 35 and 50 years old, not all of them consult because it is still accepted that suffering during menstruation or losing a lot of blood is normal. This is not the case and it can have an impact on their health”says Professor Hervé Fernandez, head of the obstetrics and gynecology department at CHU Bicêtre.
What impact on the lives of the women concerned?
According to a study conducted in the United Kingdom with 1,000 women who have or have had heavy periods and published in 2019, 92% of them feel irritable or moody, 87% of them feel extremely tired or 74% of them complain of anxiety.
Bleeding which can also affect them in their personal or professional life. 43% report having had to miss work because of heavy periods, while 72% say their sex life is affected.
Abundant blood loss can also have a direct impact on women’s health, and can in particular be the cause of severe fatigue, dizziness, anemia or, in certain cases, depression. “When a woman goes to see her general practitioner for severe fatigue, it is important that he asks her about the amount of blood she loses during her period.continues Professor Fernandez.
What are the causes of heavy periods?
Heavy periods can have multiple causes, classified between structural causes (polyp, adenomyosis, malignancy or even hyperplasia) and non-structural causes (coagulopathy, dysfunctional ovulation, endometrial disorder, iatrogenic or not yet classified).
On the outskirts of menopause, hormonal upheavals causing very heavy periods and sometimes disabling pain in the lower abdomen are common, especially when the endometrium thickens, which is a non-structural cause.
Heavy periods can also be due to the insertion of a copper IUD, especially in the first few months. Since the IUD is a foreign body surrounded by copper, it can cause chronic inflammation of the endometriumwhich can be reflected in heavy periods and small losses outside of periods
But in more than half of the cases (55%), women who suffer from abnormal bleeding have a pathology of the uterus. Polyps are the most common cause of uterine bleeding: these hormone-dependent growths are found in 10 to 33% of patients who suffer from menorrhagia. These polyps can also have a detrimental impact on fertility.
Heavy periods: how is the diagnosis made?
When an abundance of periods is identified, the gynecologist carries out an assessment of these abnormal bleedings, which may include the following examinations:
- Blood tests;
- A Pap smear ;
- An endometrial biopsy, systematic from the age of 45 or in the event of a risk factor for cancer;
- Echosonography, ultrasound with injection of 3 to 5 ml of liquid into the uterine cavity in order to optimize the visualization of pathologies of the uterus;
- A hysteroscopy, the introduction of a mini-camera into the uterus to view the inside of the uterus. This examination is not painful.
What is the treatment for heavy periods?
Treatments for menorrhagia will depend on whether or not the patient wants pregnancy, the cause of her heavy periods or whether or not she wants to keep her uterus.
If you want to become pregnant:
For structural causes of heavy periods, the National College of Gynecologists and Obstetricians (CNGOF) recommends first-line medical treatment – hormonal treatment, treatment with tranexamic acid or non-steroidal anti-inflammatory drug. This treatment by copper IUD is effective between 50 and 70%. In case of failure of this treatment, curettage is the only surgical solution that can be proposed.
In the event of a polyp or fibroid, the CNGOF recommends their removal by natural means under visual control with a camera, called hysteroscopy.
If there is no longer any desire for pregnancy:
For non-structural causes, first-line medical treatment is recommended and, in case of failure, second-line treatment with techniques such as radiofrequency treatment. A classic removal of the uterus can be considered if the patient does not wish to keep her uterus.
In the case of an intrauterine polyp or myoma, specialists recommend a combination of medical treatment and hysteroscopic surgery. Removal of the uterus is sometimes necessary as a last resort if the fibroids are very largeor too many.
Today, minimally invasive surgical solutions for treating pathologies that cause heavy periods or abnormal bleeding (such as polyps, fibroids, or functional pathologies of the endometrium) can be performed outside the operating room, without the constraints of general anesthesia. These interventions are intended for women whose cause of bleeding is attributed to an intrauterine pathology, polyp or fibroid of less than 20 mm, or when the disorder is functional (menorrhagia without a determined cause or thickening of the endometrium without desire future pregnancy).
Abundant periods: what natural solutions?
During heavy periods, you can consider taking iron to avoid suffering from anemia.
Of the antihemorrhagic plants can also participate in reducing the excessive volume of menstruation, in particular horsetail or shepherd’s purse.
In addition, you can massage your stomach once or twice a day for the duration of your period with two essential drops of cistus ladaniferous mixed in neutral vegetable oil.
Menstrual bleeding: when to worry?
If you suffer from symptoms related to your heavy periods such as intense fatigue, paleness, shortness of breath on exertion or even pelvic pain, it may be useful to consult a health professional.
Also beware of vegetarian or vegan women, who can be iron deficient more quickly in the event of heavy periods.
Sources:
- Heavy periods: are you ready to talk to your GP?
- Press kit “Abundant periods, new therapeutic options by surgery outside the operating room”
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