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Know your flow: Gynae insights on heavy menstrual bleeding


It’s important to understand your period and menstrual cycle. The more you know, the better you can manage your period and spot anything unusual should this crop up at any time.

We often get asked about heavy menstrual bleeding and more specifically, understanding when your bleed is heavy and how to manage it. Here, gynaecologist Anne Henderson answers 6 key questions to give you the low down on heavy menstrual bleeding.


How do you “get to know” your flow? What should you be looking out for?

“For most women, their menstrual bleeding will settle down into a regular pattern each month. The flow will vary from person to person which means that some women will be fortunate enough never to experience heavy periods, and will always have short, light and a pretty manageable flow. In many cases, the pattern of menstrual flow will run in the family and one of the major controlling factors is thought to be genetic inheritance. I usually recommend that women look at the family history to give them an idea of what to expect. What I would recommend looking out for is any change to your usual menstrual flow, whether flow becomes increasingly heavy/lighter or more frequent/spaced out. This could possibly indicate an underlying problem, for example, a hormonal issue, although that is not necessarily the case. Any change which is persistent and lasts longer than three months i.e. three cycles should be discussed with the GP or a Practice Nurse.”


What does a “heavy menstrual flow” look like? What are the signs your flow is heavy?

“Heavy menstrual flow is very subjective, and I regularly see patients who believe their flow is heavy, yet in comparison to others, this is not the case. A good benchmark, however, is when there are any episodes of clots and flooding through clothing or soaking bedding overnight, then this indicates severe heavy menstrual flow. Women *should* also be able to use a regular to super absorbency pad or tampon, changing every 3-4 hours or so. This is within ‘normal’ parameters. Anyone who is having to use both pads and tampons or change more frequently than two hourly is likely suffering from severe heavy bleeding. The situation can be more difficult to monitor with a menstrual cup for obvious reasons but if you’re having to change a menstrual cup more frequently than two hourly, the same advice would apply.”


Is there an official classification system for this?

“Unfortunately, there is not a clear-cut classifications system which is applicable to clinical practice. Research has been done looking at the total amount of blood loss over a menstrual period which is more likely to be associated with anaemia. But, this involves weighing sanitary pads/tampons and accurately measuring the volume of blood loss. This is obviously totally impractical in normal life!”


If you have a heavy flow, when is it advisable to seek advice from a medical professional?

“I have outlined the main guidelines for seeking medical advice with persistent changes to the menstrual cycle over a three month stretch in the previous paragraphs. I would also recommend that you seek help if you start to develop any symptoms of anaemia. The most common cause of anaemia in fertile women is heavy periods. These symptoms include chronic fatigue, general lethargy, increased headaches, muscle weakness and low mood. Any of these should prompt you to seek medical advice. I would also recommend seeking review if the menstrual bleeding is not only heavy but also associated with dysmenorrhoea or period pain – particularly if this is severe.”


Can heavy flow be a sign of a condition? Is this always the case?

“Most cases of heavy menstrual bleeding are described as dysfunctional or hormonal i.e. they are not associated with any underlying pathology, but are usually constitutional and probably largely genetically inherited, as I have outlined above. Some cases, however, will be associated with a gynaecological condition such as fibroids, uterine polyps, endometriosis, and pelvic infection amongst other causes. A GP will be able to give practical advice and carry out investigations for these conditions.”


Do you have any expert tips/advice for someone who has to manage heavy menstrual bleeding?

“My main advice is to seek advice before things get “out of control” and before your general health has been affected by heavy bleeding. Too commonly this is not reported to doctors or specialists such as myself. Chronically heavy menstrual bleeding is not only associated with an increased risk of anaemia and other problems but can have a very damaging impact on the overall quality of the person’s life. This is not only on a personal basis but also professionally. It can be linked with absence from work and poor performance. Many women also become mentally low as a result of the draining effect of the monthly cyclical bleeding. Subclinical depression is something which I see on a regular basis. The best way to prevent this pattern from developing is to stick to the “three-month rule”. Seek advice from your GP or medical specialist if your monthly cycle is starting to impact adversely on any part of your life.”

Thanks to Anne for providing these insights! For a real story about someone who lives with heavy menstrual bleeding, head to this blog here. Join in the conversation and follow us on Twitter, Facebook and Instagram.

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