Heavy periods

In this episode of PodMD, experienced Gynaecologist, Obstetrician and Laparoscopic Surgeon Dr Ruth-Ann Sterling will be discussing the topic of heavy periods, including what heavy periods are, the current treatment options available, warning signs to look out for, when to refer and more.


  • Transcript
    Please note this is a machine generated transcription and may contain some errors.
    *As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.

    Today I’d like to welcome to the PodMD studio Dr Ruth-Ann Sterling

    Dr Ruth-Ann Sterling is an experienced Gynaecologist, Obstetrician and Laparoscopic Surgeon providing care in Liverpool, Norwest and surrounding areas. Ruth-Ann is a Fellow of the Royal Australian College of Obstetrics & Gynaecologists and has been caring for women in Southwest Sydney for over five years.

    Ruth-Ann completed her medical degree at the University of Sydney and completed her training in major teaching hospitals in Newcastle, Sydney and London. Ruth-Ann is published in various women’s health areas and actively participates in teaching medical students and registrars. She is also the RANZCOG training ITP coordinator at Liverpool Hospital.

    Today, we’ll be discussing the topic of heavy periods.

    *We do hope you enjoy this podcast but please remember that the advice here is of a general nature and is not intended as specific advice about a given patient. The views and opinions expressed in this podcast are those of the doctor, not PodMD.
    If you do have a patient on whom you require specific advice, then please seek advice from a colleague with appropriate expertise in that area.

    Ruth-Ann, thanks for talking with us on PodMD today.

    Ruth-Ann: Thank you for having me.

    Question 1
    The topic of today’s discussion is heavy periods. Ruth-Ann, Can you describe for our listeners what heavy periods are?

    Ruth-Ann: Heavy periods are essentially excessive menstrual blood loss that interferes with a women’s physical, social, or emotional quality of life. I consider someone having heavy periods if they’re passing clots larger than $0.50 pieces. If they’re changing their pads or tampons every hour, they’re having to change their pads or tampons at night time. If they’re bleeding through their clothing, or if they’re having menstrual bleeding lasting for more than 8 days.

    Question 2
    How would a patient with heavy periods typically present?

    Ruth-Ann: So patient with heavy periods presents in a variety of ways. Often a woman doesn’t even really realise that she’s having heavy periods because it’s just normal for her and I may not even recognise it as being heavy. But they may present with anaemia or feeling unwell, they may also present feeling overwhelmed with their life, especially at the time of their period, so having difficulty attending work, therefore having financial and job concerns or constraints.

    And just, you know, the periods are affecting their life in such a way they can’t go out. They have to worry about what kind of clothes they’re wearing. And often they’re quite exasperated by it and it’s quite a difficult situation to deal with. And sometimes they present with other things such as other symptoms of chronic disease or thyroid problems and the period is just one aspect of that.

    Question 3
    What are the risks of the condition?

    Ruth-Ann Sterling: The risks of having heavy periods are multifold. You have the medical risks, so you know, developing anaemia and those symptoms such as tiredness, fatigue, shortness of breath, sometimes heavy periods is a sign of other gynaecological issues such as endometriosis and so it comes in that constellation of symptoms such as pain, pain with the periods, pain outside of the periods and then there are other risks such as social risks to the patients, you know really, as I said affecting their life in general and how they interact with the world.

    There’s also risk, depending on the cause of the heavy menstrual bleeding, such as fibroids, and of course, and the extreme case cancer. So it’s important to kind of fully investigate this and help the woman as best we can. So investigation wise I would normally recommend at least the pelvic ultrasound at the end of her period to assess the endometrial lining. Depending on the woman’s age, sometimes I recommend and endometrium sampling and of course things like full blood counts and thyroid function tests and other investigations for causes of the heavy menstrual bleeding needs to be done.

    Question 4
    What are the treatment options?

    Ruth-Ann: Treatment options like anything in medicine are medical and surgical. You have non hormonal management such as NSAIDs or tranexamic acid. There’s hormonal control such as the pill or progesterone implants such as the Implanon or the Mirena. And then there’s surgical managements such as endometrial ablation, there’s also at the you know the extreme end hysterectomy but also depending on what’s causing the heavy menstrual bleeding, such as things like fibroids, you may want to do embolization. There’s resection, there’s myomectomy, so it really depends on what is causing the heavy menstrual bleeding. And then managing from that point on.

    Question 5
    Have there been any developments in treatment in the last years or are there any in trials or development now?

    Ruth-Ann: Well, I think the main thing that has changed how we managed women with heavy menstrual bleeding is the Mirena device. And since then, because of its efficacy, we now do fewer hysterectomies. But also there has been evolution in technology and so the way how we conduct our perform ablations have changed from resections to using radiofrequency and there have also been advances in interventional radiology such as uterine artery embolization, which we do for women with fibroids, is an option for women with fibroids and. things like that. So few things that there’s always something in the works and there are few things that have helped us manage women with heavy menstrual bleeding more efficiently in it let’s say.

    Question 6
    Are there any warning signs a GP or their patient can look out for?

    Ruth-Ann: For older women, mainly, I think it’s important that if her periods have changed significantly from what she is used to having, that that warrants investigation now many times, that may simply be because she’s approaching menopause, but it’s impossible to just say that just by say, looking at her, just talking to her. I think it it’s very important to get an endometrial sample in these women to rule out things like hyperplasia or endometrial cancer. And so that’s what I always offer those women. I just think you can’t assume anything.

    Question 7
    What is the likelihood of recurrence of the condition?

    Ruth-Ann: Recurrence is quite difficult to quantify because it really depends on the management option that’s been chosen, for example, within endometrial ablation, you know you’re looking at a success rate of approximately 80%, but that means that about 20% of people will need further management like a hysterectomy. So though it’s very successful and even if it’s successful for a little while, the patient may come back years later, having a recurrence and needing further investigation and management, so it’s hard for me to say specifically what the recurrence rate is but for all of these women, that’s why it’s important to kind of follow them up and make sure they’re happy with what their periods have become. And if they’re not, then you know, re-refer. Or look into it further and see how best we can we can help them.

    Question 8
    When should a GP refer?

    Ruth-Ann: That’s a little bit difficult. I think it’s really up to the GP because everyone is a bit is happy to manage things to different extent. Since I think GP should refer if they are concerned, but if they are happy to investigate and start some initial management, then you know I think that’s quite reasonable as well. I like to see, I’m happy to see patients if they’re just wanting their options and to do a full discussion with them. So really, I think when a GP chooses to refer a patient is up to them, as many GP’s are happy to manage women with heavy menstrual bleeding as long as the investigations are all normal. I think if a GP is concerned that they should refer. As well as if there’s, you know, something suspicious on the investigation or if they’re managed to a certain point and feel like further options are needed then they should refer. Also for patient is wanting surgical options then clearly refer then.

    Question 9
    What role does the GP play in the treatment of the condition?

    Ruth-Ann: I think the most important role that GP plays is by identifying the patient in the 1st place with heavy menstrual bleeding. Often, as I mentioned, the patients don’t even think about their periods in that regard and may not even recognise that the amount of bleeding that they’re having would be considered to be heavy. And they may not even realise that there are ways for them to get help in terms of that area of their life. So I think it’s very important that GP can identify those women and offer that. Also the GP is important and follow up of these patients. As I mentioned, not all management options will be successful for every patient and therefore they may need to be re referred for further management options.

    Concluding Question
    Thank you for your time here today in the PodMD studio. To sum up for us, could you please identify the three key take home messages from today’s podcast on heavy periods?

    Ruth-Ann: The three take home messages that I would like to have gotten across is that identifying the patient with heavy menstrual bleeding is a key initial step. Two, that there are many management options and the patient can choose which one is right for her. And three is that I’m happy to see someone, even if they just want to speak about those options. That the GP is not required to start the initial management. If they do, that’s great. But if the patient just wants to discuss it, I’m usually quite happy to see a patient in that regard.

    Thanks for your time and the insights you’ve provided.

    Ruth-Ann: Thank you

*As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.