Heavy periods : causes and treatments.

Gen 19, Mr. Ihab Wissa

Your menstrual cycle is controlled by certain factors including your ovarian hormonal production, the local enzymes and substances within the uterus itself and the health status of the womb (uterus) and its lining(endometrium). You may suffer with heavy periods for a variety of reasons. Excessive menstrual blood loss may have a detrimental effect on your physical, emotional and social quality of life.

Dysfunctional uterine bleeding

This is the commonest reason for abnormal heavy menstrual loss. In simple words, DUB is diagnosed whenno specific reason is found to be causing the heavy menstrual loss. A range of medical treatment options – either hormonal or non-hormonal – is available to treat DUB. Mirena IUS(coil) could be of much help in certain cases.


Polyps are fleshy benign growths, which can be found on the cervix, in the uterine cavity or elsewhere. Polyps inside the uterus may be the main cause for a ‘heavy period’ or for irregular bleeding. An ultrasound may be required to confirm the diagnosis.Minor surgical procedure in the form of Hysteroscopy is usually sufficient to deal with uterine & cervicalpolyps.


Fibroids are a type of benign growth, which occur mostly within the uterus. Depending on the position and sizes, fibroids can be troublesome, and can cause heavy menstrual flow, pain or other symptoms. USS is essential to identify and measure fibroids in order to provide you with appropriate clinical advice.

A wide range of medical and surgical treatments is offered and will be discussed with you. You will be provided with a variety of options to choose from depending on your symptoms, the results of different tests and your own wishes. Fibroids which are small and embedded within the muscle of the uterus may not need any form of intervention. Ifremoval of the fibroids is advised, it may be done either through a ‘Key-Hole’ surgery – laparoscopy orhysteroscopy, or through an open surgery.

Medical Treatment

Different types of treatment include the non-hormonal options such as tranexamic acid, non- steroidal anti-inflammatory drugs, or the hormonal options, which include oral contraception pills, oral or injectable progesterone, and GnRH analogues.

Mirena IUS

This is a very efficient treatment for heavy menstrual flow, and an efficient contraception as well. It is licensed for a period of 5 years.

Endometrial ablation

This is an effective way of treating heavy menstrual cycles when there is no specific reason. It is also suitable for the management of the very small fibroids.

Before you go through this procedure, you must be aware that it is strongly recommended that you use a permanentreliable form of contraception. Pregnancy outcome following this procedure is not known, and therefore, youshould not seek pregnancy after having an ‘Ablation Procedure’.

Surgical removal of fibroids

Myomectomy (surgical removal of fibroids) may be necessary to relive the symptoms caused by largefibroids. It may also be a treatment option for a patient who wishes to preserve her fertility.

If this option is warranted, you will be given a detailed account of all the pros and cons, and the possiblescenarios. You will then be able to make a well-informed choice.


If more conservative options could not help with your symptoms or if you suffered with side effects for example,you may wish to have a more radical solution for what you may see as a long-term problem that prevent you fromleading a pleasant and enjoyable life.

You will certainly find a very supportive and professional advice which will provide you with actualinformation which will guide you to make the right decision.