Heavy menses make her feel tired

Q I am 43 and healthy. However, my periods have become increasing heavy in the last year. I now need to use double protection with tampons and pads to absorb the blood clots. I feel the need to stay at home, not only because of the "blood flooding", but also because I feel very tired during my menstruation.

I have started taking iron tablets and this makes me feel less tired. Do I need to consult a doctor? Can heavy menses affect my health?

A About one in three women feel that they have heavy menstrual bleeding (HMB).

This is a subjective perception that their periods are excessive, resulting in a deterioration in their well-being. It is often difficult to compare one's periods with another woman's.

But bleeding for more than a week - with blood clots, flooding, and a need to regularly change or use double protection - is considered having a heavy period.

Furthermore, if the periods lead to fatigue, breathlessness or fainting, these may suggest that the blood loss is excessive.

There are different causes of HMB such as fibroids, hormonal problems, infections, side effects of medications, blood-clotting disorders and, occasionally, cancer. Therefore, the correct treatment varies, based on the cause.

Very often, however, no apparent cause is found. In these cases, known as dysfunctional uterine bleeding, treatment that addresses the patient's symptoms will be appropriate.

If you experience signs that suggest HMB, it is prudent to have it assessed so that you can be helped appropriately.

Your doctor will typically ask you about your health, examine you and offer you a pelvic ultrasound scan.

At the same time, if appropriate, you may be given a cervical smear test and also testing for genital tract infections.

Depending on your situation and your pelvic ultrasound scan, you may be asked to have a sampling of your womb lining (endometrium) taken to exclude endometrial hyperplasia (pre-cancer of the womb lining) and cancer. A full blood count is also taken to assess for anaemia. If necessary, you may also be asked to test for thyroid and clotting diseases.

Dysfunctional uterine bleeding generally causes inconveniences, affecting a woman's quality of life. But in cases associated with severe anaemia, the low-blood count can lead to rapid or irregular heartbeat, as the heart pumps more vigorously to compensate for the lack of oxygen in the blood.

In the long term, this can lead to heart failure.

HMB that arises due to medical conditions like thyroid disease and cancer will have to be managed differently, as the underlying condition has to be treated as well. In some cases, your doctor may offer progestogen medicine to arrest the bleeding, and iron tablets to replenish the iron lost.

If the anaemia is significant, a blood transfusion will be offered. Thereafter, long-term control of HMB depends on the cause and severity of the problem. It also depends on your desire for fertility.

If there is no medical cause and your blood count is normal, some women may choose to observe their menses with a menstrual calendar and seek treatment if it becomes problematic.

In women who require contraception, either the hormone levonorgestrel-releasing intrauterine system or oral contraceptive pill would be offered as a first-line treatment to control HMB and prevent unplanned pregnancies.

These can also be used where there is no need for contraception as they are also very effective in preventing heavy menses. Controlling HMB allows a woman to live her life without being tied down by her periods, and also reduce the risk of long-term health problems.

Dr Tan Toh Lick

Consultant obstetrician and gynaecologist at Thomson Women's Clinic (Jurong)

This article was first published on September 8, 2015.
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