Period problems/menstrual dysfunction

What is a period?

The lining of the womb (uterus) thickens in readiness to accept a pregnancy if an egg is successfully fertilized. If you don’t become pregnant the womb lining breaks down and comes away as a period.

In a normal menstrual cycle, a woman loses menstrual approximately 2- 3 tablespoons of blood over 4-8 days every 28 days on average. Some women lose up to 5-6 tablespoons of blood and this is abnormal and may result in low blood levels (anaemia).

What are heavy periods?

Your periods are probably heavy if you have one of the following:

  •  Soak through a tampon or pad every 1-3 hours
  •  You pass clots larger than 50 pence size or “flood”
  • Double protection is essential (tampons and towels)
  • You need to change your tampon more than every two hours
  • Blood soaks through your protection into the bed sheets at night
  • The period lasts for more than a week
  • You have become anaemic
  • Your quality of life is being excessively affected by your period

How is the diagnosis made?

Asking relevant questions and performing an examination of the abdomen and pelvis is important in identifying the cause of heavy periods. The diagnosis is often confirmed by investigations which include:

An ultrasound scan may be required to assess the size, shape and inner lining (also known as the endometrium) of the womb. A scan will also check the ovaries to exclude cysts.

Blood tests are done to exclude anaemia or low iron levels. Occasionally hormone levels are measured, particularly if the menstrual cycle is irregular.

Pipelle endometrial sample-A sample of the lining of the womb (endometrium) may be obtained to check for abnormalities. This can be done during a vaginal (internal) examination at the outpatient visit, using a very fine plastic tube, which is passed through the neck of the womb (cervix).

Hysteroscopy is a look inside the womb with a small telescope and camera at which time a sample of the lining of the womb is obtained to make sure there is no abnormality within the cells. Common abnormalities such as polyps or fibroids can be detected and be removed at the same time.


What treatment options are available?

Some Women are happy to be reassured that their periods are normal and no abnormality can be found.

If treatment is required, there are a number of options available.

Oral Medication

Non hormonal tablets such as Tranexamic acid can be useful as they are only taken during the period and can reduce the amount of blood loss by up to 50%.

Mefenamic acid (Ponstan).
This tablet is very effective for period pain and can also reduce the quantity of bleeding by about 30%.

The combined oestrogen/progesterone contraceptive pill or the progesterone only mini-pill are both useful for treating heavy periods and provide contraception. This needs to be taken throughout the month.

Mirena intrauterine system (IUS)- This is a plastic progesterone hormone coated device that is inserted into the lining of the womb. It reduces blood loss by thinning down the lining.


Surgical treatment

Endometrial ablation-This is a treatment that destroys most of the lining of the womb. This is only suitable for women who do not desire more children

Hysterectomy – 
This is a surgical procedure to remove the womb and abolishes bleeding permanently. This is major operation with associated risks

Additional information is available on all of the above treatments.