Regular bleeding as it is known today is a relatively new experience for women. In the last one hundred years, the number of periods experienced by women has increased from an average of 40 to 400.

Heavy vaginal bleeding usually refers to heavy periods (Menorrhagia), although it can also mean bleeding between periods and/or periods lasting longer than a week. The amount of blood that you lose will depend on your own hormone levels through your cycle. Bleeding differs between women and the perception of what is a heavy bleed is often very different, what is heavy for one woman, may be fairly light for another. The average period lasts for five days and a woman can expect to lose about two tablespoons of blood during that time, although it does look a lot more.

A heavy period is defined by the medical profession as having a total blood loss of more than 80ml which is equivalent to half a cupful of liquid. Other definitions may include periods that last longer than seven days, one where large clots of blood are passed or if flooding occurs.

It can be a symptom of other conditions, such as endometriosis, fibroids or pelvic inflammatory disease and it is possible that having a coil fitted for contraceptive purposes can make periods heavier and/or more painful. They can be caused by high levels of the female sex hormones or by an imbalance in the prostaglandins 3 which are naturally occurring substances in the body. According to the RCOG (Royal College of Obstetricians and Gynaecologists), approximately one in 20 women report heavy blood loss.

There is also a danger of developing anaemia due to iron deficiency so it is important to make sure that you keep to a well-balanced diet. You may find that your daily life is also affected because of the flooding and/or pain. Treatment with hormones or the contraceptive pill and iron tablets may be tried and you may also be given a “trans-cervical re-section” of the lining of the uterus, where the lining of the womb is taken away.

According to Herbert Goldfarb, 70% of women who experience problems with their periods are at the extremes of their menstrual life, that is they are just beginning or they are reaching menopause. He also states that 70% of them are also not ovulating 5 and that this can be the most common cause of heavy bleeding. This lack of ovulation results in a woman producing no progesterone which means that the oestrogen production enables the lining of the womb to carry on growing without stopping. When the lining eventually begins to break down, the resultant blood loss is extremely heavy.

In the US, the MS (Medicine or Surgery) Study is a nationwide research study being conducted in four American cities to understand how well commonly used treatments work for women with abnormal uterine bleeding.

• loss of 80ml of blood per period
• bleeding lasting longer than seven days
• passing of blood clots
• flooding if you need to change sanitary protection every two/three hours

What Treatment is Available?

Observation Women who are not pregnant and who experience a single episode of heavy bleeding, usually require no medical treatment. Resting will often reduce the amount of blood passed. However, all women who experience heavy bleeding for over 24 hours should seek medical advice.

Drug Therapy Treatment with hormones (Such as Danazol) or the contraceptive pill (combined oestrogen and progesterone or progesterone only) in an attempt to regulate the bleeding.

Other such treatments may include the use of an intrauterine device or coil called Mirena which is also used to prevent pregnancy from occurring.

Iron tablets may be given where there is a risk of anaemia. Some NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen may be offered as these may help reduce the amount of blood passed as well as the pain of cramps.

Surgical Treatment originally consisted of the D&C (Dilation and Curettage) which scraps the lining of the uterus to determine a diagnosis however, this is no longer recommended. The more usual treatments will include Endometrial Ablation and Resection or thermal balloon ablation or Laser Ablation, both of which remove as much of the lining of the uterus as possible.

In some cases, a sub-total hysterectomy (removal of the uterus and cervix) may be recommended, where there is no response to treatment.

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