Bleeding periods: causes, treatment and advice

A third of women suffer from heavy periods. Up to 15% suffer from haemorrhagic periods. The causes can be numerous. Fortunately, there are solutions to regulate menstrual flow. Elia tells you more about this disabling phenomenon.

What are bleeding periods?

Haemorrhagic periods are characterized by a heavy flow of blood, which is difficult to controlwith conventional sanitary protection such as tampons or pads. It's a restrictive form of heavy menstruation. Menstrual bleeding is referred to as menorrhagia.

How do I know if my period is hemorrhagic?

Periods are said to be hemorrhagic when blood loss exceeds 90 ml, the equivalent of a full coffee cup. The volume of blood lost then becomes embarrassing. Typically, the women concerned have to change their sanitary protection very often (sometimes every hour for several consecutive hours), day and night.

Menstrual haemorrhage can also be distinguished by its abnormally long duration: 7 days or more. Loss of large blood clots is also common.

Types of bleeding and menstrual bleeding

Menorrhagia can be broken down into three types. There are :

• Hypermenorrhea: menstrual flow is very abundant (over 90 ml), but the duration of menstruation is normal (between 3 and 7 days maximum);
• Macromenorrhea: menstrual flow is normal to abundant (between 35 and 90 ml), but menstruation lasts too long (more than 7 days);
• polymenorrhea: menstrual flow is both very abundant and very long.

How to tell the difference between haemorrhagic and heavy periods

A period is considered heavy when the total volume of bleeding exceeds 40 ml.

To calculate their menstrual flow and see whether their periods are normal (35 to 40 ml), heavy or hemorrhagic, women can refer to the Higham score. The principle is to fill in a menstruation evaluation grid over a given period, indicating :

• Total number of lightly, moderately or heavily soaked pads or tampons;
• The total number of small or large blood clots lost (smaller or larger than 1 cm).

A number of points is awarded for each pad, tampon or clot. A total score of 100 or more is indicative of bleeding.

What are the different causes of menstrual bleeding?

Women can experience bleeding periods for a variety of reasons.

The copper coil

The copper intrauterine device (IUD) can causeinflammation of the uterus, resulting in thickening of the endometrium (the mucous membrane lining the inner surface of the uterus, where menstrual bleeding originates). The result? When theendometrium disintegrates in the absence of fertilization, bleeding is heavier than usual.

In most cases, the body eventually becomes accustomed to the presence of the IUD. A few months after insertion, the flow tends to diminish, even if it often remains abundant.

The presence of a uterine fibroid or ovarian cyst

A fibroid is a tumour located in the muscle cells of the uterus. It is benign, so cannot degenerate into cancer. Often silent, this pathology is symptomatic in 20-50% of cases. Symptoms include menorrhagia, pain and frequent urination.

Also benign, ovarian cysts are fluid-filled tumors. In 90% of cases, it resolves on its own. This is known as a functional ovarian cyst. Organic cysts, on the other hand, usually require treatment.

Endometriosis

Particularly painful, endometriosis is characterized by the presence of endometrial fragments outside the uterus. It's not uncommon for sufferers of this chronic gynaecological condition to experience heavy menstrual bleeding.

Other causes

Menstrual bleeding can also be the result of :

• Hormonal imbalance (excess estrogen or deficiency of progesterone, or both - these imbalances are particularly noticeable at puberty or during the premenopause);
• Uterine polyps (benign growths);
• premature miscarriage;
• adenomyosis (a particular form of endometriosis affecting the uterus or myometrium, i.e. the uterine muscle);
• endometrial hyperplasia or hypertrophy (an increase in the volume of the uterine lining caused by hormonal imbalance);
• a coagulation disorder (hemophilia or Von Willebrand disease, for example);
• Certain diseases or conditions, such as lupus erythematosus, kidney failure, liver dysfunction and other endocrine disorders;
• or endometrial cancer.

But don't worry: endometrial cancer is associated with heavy bleeding in less than 1% of menorrhagia cases.

What are the treatments for menstrual bleeding?

Treatment of menstrual bleeding depends directly on its cause. For this reason, the cause should always be investigated by a specialist.

Medical treatments

When the copper coil is the cause of bleeding, the problem can be solved by replacing it with a hormonal coil containing levonorgestrel (a synthetic hormone similar to progesterone). This will limit the thickening of the endometrium, thereby reducing menstrual flow.

A progestin-only pill, i.e. one with a low progesterone content, may also be considered. This contraceptive treatment will also regulate endometrial growth. Alternatively, progesterone-based hormone tablets can be taken. This treatment should be taken for 10, 15 or 20 days a month, but preferably for a short time, due to the risk of associated meningioma (benign tumour of the meninges). It is therefore preferable, for example, while awaiting surgery.

Ultrasound, a non-surgical treatment

Ultrasound destroys benign tumors, cellular lesions or low-risk localized cancers by heating, without damaging surrounding healthy tissue. No incision or anesthesia is required.

Surgical treatments

Ovarian cysts, fibroids or uterine polyps may require surgery, depending on their size and number, and their impact on menstruation. The same applies to adenomyosis or endometrial hypertrophy. Several surgical techniques are available.

Operative hysteroscopy

Also known as gynaecological endoscopy, operative hysteroscopy involves operating inside the uterine cavity via the natural route. The procedure is performed outside the menstrual period - or outside the bleeding period for women in the premenopausal phase - ideally in the first part of the menstrual cycle. At this time, the uterine mucosa is thinner. This facilitates the surgeon's work.

For polyps or fibroids, operative hysteroscopy is only indicated if the tumour(s) is/are located under the uterine mucosa. Indeed, when they are interstitial (i.e. located inside the uterine wall), it is impossible for the surgeon to access them with the hysteroscope.

Hysterectomy

Hysterectomy is a radical operation. The entire uterus is removed. During the same operation, the surgeon may also remove other organs, such as the cervix, ovaries or fallopian tubes. In women approaching menopause, only the ovaries are normally removed.

Patients may opt for hysterectomy, even if they have not tried medical treatment or light surgery beforehand.

Uterine embolization

This minimally invasive procedure is designed to block the uterine arteries that irrigate fibroids or endometriosis lesions (in the case of adenomyosis, or endometriosis inside the uterus). It is used as an alternative to hysterectomy for women wishing to retain their uterus.

However, there is a risk of failure. The risk of uterine necrosis, although rare, cannot be ruled out.

Why do I need to check my anaemia regularly in the event of menstrual haemorrhage?

Menstrual bleeding can lead to iron-deficiency anemia. Iron is an essential element in the production of red blood cells, which play a vital role in oxygen transport. That's why it's important tohave regular blood tests to assess your state of health. If necessary, your doctor can prescribe iron supplements.

Iron-deficiency anemia can cause fatigue, paleness, headaches, shortness of breath on exertion, dizziness or vertigo.

Menstrual pants for bleeding periods

Pads and tampons, even for very heavy flows (super plus), are not always enough to control a very heavy blood flow. Much more absorbent menstrual panties can hold the equivalent of 3 to 4 conventional tampons. They are therefore particularly recommended for bleeding periods.

As well as being effective (maximum absorption for the "hemorrhagic" range, a sufficiently wide band to prevent the risk of leakage), menstrual pants are comfortable, but also refined.

Their secret? They incorporate a layer of eucalyptus fiber (Tencel) with anti-odour, antibacterial and ultra-absorbent properties, guaranteeing dry protection all day and night long. This layer is complemented by a waterproof PUL membrane, for enhanced anti-leak protection.

At just two to three millimeters thick, Elia menstrual briefs go unnoticed under your clothes. It's almost as if you were wearing classic lingerie! Our entire collection is made from organic cotton. More respectful of the environment, the cultivation of organic cotton consumes 91% less water than traditional cotton. So when you wear Elia menstrual briefs, you're also doing your bit for the planet!

FAQ about bleeding periods

When do we talk about bleeding periods?

How can menstrual bleeding be stopped?

How can you tell heavy periods from bleeding?

What are the remedies for menstrual bleeding?