Heavy Menstrual Bleeding and Dysmenorrhoea

Before writing today’s blog, I asked my final test medical student. She went to an all girl’s school and she commented that all the girls talked about heavy periods and period pain.

So what classifies heavy menstrual bleeding? Well the technical definition is the loss of more than 35ml of blood, but the reality is that whatever is bothersome for you is an issue. A “normal” period can last 7 days, with 2-3 days of heavy bleeding where a pad or tampon can be changed every 3-4 hours. Every woman’s bleeding patterns can be different so it is difficult to compare one woman to another. I think that it is important that if you are concerned about the amount of bleeding you have, then you should see your Doctor.

What is abnormal is bleeding after sex (post coital bleeding) and bleeding between periods (intermenstrual bleeding). If you have any of these symptoms it is important to see your Dr.

With respect to period pain, it is also different for everyone as is everyone’s threshold to pain.

Some women don’t need any pain relief for periods, others can take simple pain killers like paracetamol or ibuprofen while others are crippled in bed with a heat pack and serious analgesics and needing days off work. This may be due to being sensitive to pain but it may also be related to medical conditions. I will get to these in subsequent blogs.

For now I want to focus on what we call primary dysmenorrhoea or period pain related to periods.

There are different approaches to managing period pain:

1. Conservative measures like heat packs.
2. Medical treatment. These come in non- hormonal and hormonal options.
Non hormonal includes pain killers like paracetamol, anti inflammatories such as aspirin, ibuprofen (Nurofen), diclofenac (Voltaren), mefenamic acid (Ponstan) and naproxen (Naprogesic). Please be mindful that some children should avoid these due to triggering asthma, reflux and may stop blood pressure medication from being as effective. These anti inflammatories are all the same class so only take one, do not double up. Tranexamic acid (Cyklokapron) is also great for reducing the amount of bleeding during your periods. You need a prescription for this.

It is better to take the st the beginning of the onset of pain than trying to get on top of it once it’s set in.

Hormonal options include:
The combined oral contraceptive pill or the progesterone only pill. These keep the hormone levels relatively steady and therefore create less bleeding and therefore less pain. You can also skip the sugar pills and miss your periods completely. Chances are though that after a few months you may get breakthrough bleeding and need to have a period.

Other options include:
Implanon or Mirena. These are progesterone based. The only concern is they can cause irregular bleeding in the first few months.

Nuvaring is a plastic ring inserted into the vagina every 3 weeks and is similar to the pill. This is not government covered however and is more expensive than the other alternatives.

All of these products require consultation with your Dr prior to starting them. Everyone is different ags it is sometimes trial and error as to what may work as well af the side effect profile.

3. Surgical options for heavy menstrual bleeding are for women who have completed their families. They are senn ablation and a hysterectomy. I will talk more about these when I talk about peri-menopause.

Please let me know if you have any questions about any of the above treatments. I am happy to answer your concerns and advise you as appropriate.

See you next week!