Bleeding Periods: Understanding and Treating Heavy Menstruation

Hemorrhagic periods, also known as menorrhagia or hypermenorrhea, are characterized by exceptionally heavy and sometimes prolonged menstrual bleeding. More specifically, hemorrhagic periods occur when the amount of blood lost during the menstrual cycle exceeds 80 ml, well above the normal average of between 30 and 50 ml.

These periods may also last longer, often beyond 7 days, whereas normal menstruation is usually between 3 and 7 days. Bleeding may be so heavy that it requires frequent changing of sanitary protection, sometimes every hour or two.

Bleeding or heavy periods?

Sometimes it is difficult to distinguish between heavy and light periods.

A period is considered heavy if its volume exceeds 40 ml. However, the volume of a hemorrhagic period is twice that of a heavy period. In addition, hemorrhagic periods contain numerous clots of significant size.

There are tools, such as the Higham score, that can help determine what type of period you have.

The Higham Score: What is it?

The Higham score is a useful tool for assessing the amount of menstrual bleeding. It’s a method designed to help determine the amount of blood lost over a month. This allows women to determine whether their periods are normal, heavy, or hemorrhagic.  

The Higham score is based on a table that records the number and condition of sanitary protection used during the menstrual cycle. A score above 100 indicates heavy menstruation.

Heavy periods or menorrhagia can be caused by several factors, such as:

• Hormonal imbalance: Excessive estrogen production by the ovaries can lead to excessive growth of the endometrium, the lining that lines the uterus. This is especially common during puberty or premenopause, when hormone levels can fluctuate significantly.

• The presence of a copper intrauterine device (IUD) is another common cause. The copper in the IUD can cause inflammation of the uterus and thickening of the endometrium, which leads to increased bleeding, especially during the first few months after the IUD is inserted.

• Uterine lesions, such as fibroids or polyps, are also common causes of heavy periods. These abnormal tissues can disrupt the normal menstrual process, causing heavier and more prolonged bleeding;

• Endometriosis: This is characterized by the presence of fragments of the endometrium outside the uterus. This creates discomfort and pain, and may be accompanied by hemorrhagic bleeding in the woman who suffers from it.

• Blood clotting disorders: hemophilia, for example, can contribute to hemorrhagic periods.

Finally, age-related factors should also be considered. Adolescent girls in their early reproductive years and premenopausal women are more likely to experience heavy periods due to hormonal fluctuations and menstrual cycle irregularities.

Heavy periods are often accompanied by specific symptoms that are important to consider when determining whether medical attention is needed. These signs, in addition to heavy blood loss, include:

• Presence of blood clots: The presence of large clots in the discharge is a warning sign. Clots of considerable diameter or several clots during the same period may require medical consultation;

• Severe pain: Severe pain during menstruation that is not relieved by over-the-counter medications or lifestyle adjustments should be taken seriously. This pain may be related to uterine lesions such as fibroids or polyps.

• Symptoms of anemia: fatigue, weakness, dizziness, frequent headaches, or shortness of breath are signs that blood loss could be affecting your iron levels and overall health.

• Prolonged period duration: If your period lasts more than 7 days, this may indicate an underlying problem such as hormonal imbalance, uterine damage, or another condition that requires evaluation.

• Pain during sexual intercourse or frequent urge to urinate: These symptoms may be related to gynecological problems requiring medical attention.

Good to know : It’s essential to consult a doctor or gynecologist as soon as you notice any of these symptoms. This helps rule out any serious causes and ensure you receive appropriate treatment. Only a healthcare professional can perform the necessary tests and prescribe the appropriate treatments to relieve your symptoms and improve your daily life.  

To diagnose heavy periods, a doctor or gynecologist follows a methodical approach to identify the underlying causes and assess the severity of the bleeding. These include:

• Anamnesis: The first step is to take a patient’s menstrual history. The doctor asks questions about the characteristics of the bleeding, including its duration, frequency, and the amount of blood lost. This also includes the number of sanitary pads used per day and the possible presence of blood clots.

• A pregnancy test is often performed, including in adolescents and women approaching menopause, to rule out the possibility of an ectopic pregnancy or an abnormal intrauterine pregnancy.

• A clinical examination is then performed to look for physical signs that may indicate underlying causes, such as fibroids or uterine polyps. This examination may include abdominal palpation and a gynecological examination.

• Blood tests are also performed to assess the amount of blood loss and detect possible complications, such as iron deficiency anemia related to chronic blood loss. These tests include a complete blood count (CBC) and coagulation tests to identify possible clotting disorders.

• Hormone tests may be ordered to measure levels of female hormones (estrogen and progesterone), as well as other hormones such as thyroid hormones and prolactin, to identify hormonal or endocrine disorders.

• Imaging tests, such as ultrasound, MRI, or CT scan, may be needed to visualize the uterus and identify abnormalities such as fibroids, polyps, or adhesions;

• A diagnostic hysteroscopy may also be performed to directly examine the inside of the uterus and detect lesions or abnormalities in the uterine lining. This procedure may be accompanied by an endometrial biopsy to analyze endometrial tissue.

These tests and procedures allow the doctor to determine the precise cause of menorrhagia and to propose the most appropriate treatment for the patient.

Treatments for heavy periods vary and are tailored to the cause, severity of the bleeding, and the patient’s preferences and circumstances.  

Drug treatments

Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first choice for treating heavy periods. These medications reduce menstrual flow and associated pain by decreasing the production of prostaglandins, which are responsible for inflammation and uterine contractions. NSAIDs should never be self-medicated.

Antifibrinolytics are also effective in controlling heavy bleeding. These medications promote clotting, thus limiting blood loss during menstruation.

Hormonal contraceptives, such as birth control pills or hormonal intrauterine devices (IUDs), are very effective at regulating menstrual bleeding. These treatments restore hormonal balance, reducing menstrual flow.

Surgical treatments

When drug treatments are insufficient or if a uterine abnormality is the cause of hemorrhagic periods, surgical solutions may be considered.  

Hysteroscopy is a procedure used to diagnose and treat intrauterine abnormalities, such as polyps and fibroids. It may involve the removal of these lesions or a resection of the endometrium to reduce bleeding.

Endometrial thermocoagulation or endometrial resection by operative hysteroscopy are procedures aimed at reducing the thickness of the inner lining of the uterus to reduce bleeding. However, it should be noted that these procedures can have an impact on fertility.

As a last resort, and especially for women with no plans to become pregnant, a hysterectomy (removal of the uterus) may be suggested. This solution is permanent and eliminates any risk of recurrence.

Treatment of associated complications

Heavy periods can lead to complications, such as iron deficiency anemia due to chronic blood loss. Oral iron supplementation is often necessary to correct iron deficiency and reduce associated symptoms, such as fatigue, pallor, dizziness, and shortness of breath.

In summary, the choice of treatment depends on several factors. It is essential to consult a doctor or gynecologist to determine the most appropriate solution.

Heavy periods can have both physical and emotional consequences, such as:

• abdominal pain ;

• iron deficiency anemia;

• dehydration ;​

• physical discomfort;

• social isolation (due, for example, to having to change regularly and fearing leaks that could make the woman uncomfortable);

• anxiety.