Heavy menstrual bleeding
Heavy menstrual bleeding — part of gynaecology and women’s health at Dr. Najeeb Layyous's clinic in Amman.
In short: Heavy menstrual bleeding is period bleeding that is heavier than normal, lasts longer than usual or needs a change of pad every hour or two. Causes include fibroids, polyps, clotting disorders, the IUD and hormone imbalance, and it can lead to tiredness, dizziness and anaemia. First treatment is usually the hormonal IUD or medicines such as tranexamic acid; surgery is used when medical treatment fails.
heavy menstrual bleeding (HMB) has a major impact on a woman’s quality of life; any intervention aims to improve this rather than focusing on blood loss.
Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman’s physical, social, emotional and/or material quality of life.
Signs of heavy bleeding include periods lasting more than 8 days, needing to change pads or tampons every one to two hours, passing clots larger than about 2.5 cm, flooding through clothes, or needing double protection.
There are many causes of heavy menstrual bleeding, including organic causes such as uterine fibroids, polyps, adenomyosis, clotting disorders, and the copper (non-hormonal) intrauterine device (IUD).
The different kinds of these devices are presented in our guide to IUD contraception.
Hormonal causes are also common, especially before menopause. In some cases, the hormonal imbalance may be unexplained.
The patient may experience accompanying symptoms such as fatigue, dizziness, and iron-deficiency anemia, which can negatively impact her quality of life.
Diagnosis is based on medical history, physical examination, laboratory tests, and ultrasound.
A blood count is checked to look for anaemia. A hysteroscopy may be advised if a polyp or fibroid inside the cavity is suspected, and a sample of the uterine lining (endometrial biopsy) is taken in women with persistent bleeding between periods, in women aged 45 or over whose bleeding does not respond to treatment, or when there are risk factors for endometrial hyperplasia.
Treatment depends on the underlying cause and ranges from medication to surgery.
Consider an LNG-IUS as the first treatment for HMB in women with:
• no identified pathology or
• fibroids less than 3 cm in diameter, which are not causing distortion of the uterine cavity or
• suspected or diagnosed adenomyosis
If a woman with HMB declines an LNG-IUS or it is not suitable, consider the following pharmacological treatments:
• non-hormonal:
－ tranexamic acid
－ NSAIDs (non-steroidal anti-inflammatory drugs)
• hormonal:
－ combined hormonal contraception
－ cyclical oral progestogens.
If treatment is unsuccessful, the woman declines pharmacological treatment, or symptoms are severe, she can be offered
surgical options:
- second-generation endometrial ablation (for women who do not wish to have children in the future)
- hysterectomy (for women who do not wish to have children in the future)
-For women with submucosal fibroids or polyps, consider hysteroscopic removal
For women with fibroids of 3 cm or more, options include medical treatment, uterine artery embolisation, removal of the fibroids (myomectomy) or hysterectomy, depending on the size, number and position of the fibroids and whether she wishes to keep her fertility.
Dr Najeeb Layyous F.R.C.O.G
Consultant Obstetrician, Gynecologist and Infertility Specialist
We’re grateful for dealing with such a physician — he’s very caring and deals with each case separately. We would’ve loved to spend more time with him, however he was never in a hurry during our given time.