Heavy Menstrual Bleeding, Fibroids & Adenomyosis
Heavy or prolonged periods can affect your energy, your work and your confidence. There are many possible causes and many treatment options. Dr Laarnie Pe Benito consults at Women’s Care in Castle Hill.
What counts as heavy menstrual bleeding?
The Australian Commission on Safety and Quality in Health Care describes heavy menstrual bleeding as excessive menstrual blood loss that interferes with a woman’s physical, emotional, social or material quality of life. In practice, this means it is the impact on your life that matters, rather than a single measurement. Signs that your periods may be heavy include:
- soaking through a pad or tampon every one to two hours, or needing to double up on protection
- passing large blood clots
- bleeding that lasts longer than seven days
- flooding, or leaking onto clothes or bedding
- avoiding activities or planning your day around your period
- tiredness, breathlessness or dizziness, which can be signs of iron deficiency or anaemia
Common causes
Heavy bleeding can come from the uterus itself or from hormonal, blood-clotting or other medical causes. Often more than one factor is involved. Causes include:
- Fibroids – non-cancerous growths of the muscle of the uterus. They are common, and many cause no symptoms. When they do, they may cause heavy bleeding, pelvic pressure, bloating or needing to pass urine often.
- Adenomyosis – a condition in which tissue like the uterine lining grows into the muscle wall of the uterus, often causing heavy and painful periods.
- Endometrial polyps – small, usually benign growths in the lining of the uterus.
- Hormonal causes, including irregular ovulation, polycystic ovary syndrome (see ovarian cysts and PMOS) and the changes of perimenopause (see menopause and perimenopause).
- Blood-clotting disorders, thyroid conditions, certain medicines and, less commonly, thickening or abnormal changes in the uterine lining that need to be excluded.
Related conditions such as endometriosis can also cause heavy or painful periods; see endometriosis and pelvic pain.
When to see a doctor
See your GP, and ask about a gynaecologist referral, if your periods are affecting your daily life, if you have symptoms of anaemia, or if medicines have not helped enough. Bleeding between periods, after sex or after menopause should always be assessed. Very heavy bleeding with dizziness, fainting or severe pain needs urgent care at an emergency department.
How heavy bleeding is assessed
Assessment usually includes your history, an examination, and blood tests such as a full blood count and iron studies. A pelvic ultrasound is commonly used to look at the uterus and ovaries. Depending on your age, symptoms and findings, hysteroscopy (looking inside the uterus with a thin camera) and a biopsy of the uterine lining may be recommended to check for polyps, fibroids inside the cavity or abnormal changes in the lining. Your cervical screening should also be up to date.
Treatment options
The Heavy Menstrual Bleeding Clinical Care Standard encourages informed choice and starting with the least invasive effective option. The right choice depends on the cause, your age, whether you want to become pregnant and your preferences.
Medical options
- Tranexamic acid or anti-inflammatory medicines taken during a period
- A hormonal intrauterine device (IUD), the combined oral contraceptive pill or progestogen treatments
- Treatment of iron deficiency
- Treatment of any underlying hormonal or medical cause
Procedures and surgery
- Hysteroscopic removal of polyps or fibroids that bulge into the uterine cavity, including using the MyoSure tissue removal system
- Endometrial ablation, a day procedure that treats the uterine lining to reduce bleeding. It is intended for women who have finished having children, and contraception is still needed afterwards.
- Myomectomy – removal of fibroids while keeping the uterus, performed by laparoscopic or abdominal surgery depending on the size and position of the fibroids
- Hysterectomy – removal of the uterus, which may be considered when other options have not worked or are not suitable and a woman has completed her family. It can be performed laparoscopically or through an abdominal incision.
- Other options such as uterine artery embolisation, performed by interventional radiologists, may also be discussed for fibroids.
All procedures carry risks, which are explained before you decide. See minimally invasive gynaecological surgery for more detail.
How Dr Pe Benito can help
Dr Pe Benito’s clinical focus includes menstrual concerns, fibroids and adenomyosis. At Women’s Care in Castle Hill she can assess the cause of heavy bleeding, arrange investigations and discuss the full range of options with you, including advanced hysteroscopy, MyoSure, endometrial ablation, myomectomy and hysterectomy where appropriate.
She sees women from Castle Hill, Baulkham Hills, Kellyville, Rouse Hill, Bella Vista, Cherrybrook, Glenhaven, Dural and Glenwood, as well as other parts of the Hills District and Sydney.
Common Questions
Are heavy periods normal?
Periods vary, but bleeding that disrupts your life, causes you to feel unwell or leads to low iron is worth investigating. It is not something you need to put up with.
Do fibroids always need treatment?
No. Many fibroids cause no symptoms and need no treatment beyond monitoring. Treatment is considered when fibroids cause heavy bleeding, pain, pressure symptoms or other problems.
What is the difference between fibroids and adenomyosis?
Fibroids are distinct growths of uterine muscle. Adenomyosis is when tissue like the uterine lining grows into the muscle wall. They can look similar on symptoms, and some women have both. Ultrasound or MRI helps tell them apart.
Consultation Enquiries
Dr Pe Benito is a female gynaecologist consulting at Castle Hill Women’s Care. A GP referral is recommended for Medicare rebates on specialist consultations. Please contact the rooms to arrange an appointment.