Bleeding periods: causes, treatment and advice

One third of women would have heavy periods. Up to 15% of them suffer from bleeding periods. The causes can be numerous. Fortunately, there are solutions to regulate your menstrual flow. Elia gives you more details about this phenomenon, which is disabling to say the least.

What is a bleeding period?

Haemorrhagic periods are characterized by a very abundant flow of blood, which is therefore difficult to controlwith conventional sanitary protection, such as tampons or pads. It is a restrictive form of heavy menstruation. Menorrhagia is the term used to describe menstrual bleeding.

How do I know if my period is bleeding?

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

Menstrual bleeding can also be distinguished by its abnormally long duration: 7 days or more. The loss of large blood clots is also frequent.

Types of bleeding and bleeding periods

Menorrhagia can be divided into three types. We distinguish:

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

How to tell the difference between bleeding periods and heavy periods

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

To calculate their menstrual flow and see if 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 menstrual evaluation grid for a given period, indicating

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

A number of points is assigned 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 have bleeding periods for a variety of reasons.

The copper IUD

The IUD (intrauterine device) can causeinflammation of the uterus, and thus a thickening of the endometrium (the mucous membrane lining the inner side of the uterus, where menstruation comes from). The result? When theendometrium disintegrates in the absence of fertilization, bleeding is heavier than usual.

In most cases, the body eventually gets used to the presence of the IUD. In most cases, the body gets used to the presence of the IUD and the flow tends to decrease a few months after insertion, although it is often still heavy.

The presence of a uterine fibroid or an ovarian cyst

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

Also benign, the ovarian cyst is a tumor usually filled with fluid. In 90% of cases, it resolves itself. This is called a functional ovarian cyst. Conversely, organic cysts usually require management.

Endometriosis

Endometriosis is characterized by the presence of endometrial fragments outside the uterus and is particularly painful. It is not uncommon for people affected by this chronic gynecological disease to have abundant menstrual bleeding.

Other causes

Menstrual bleeding can also be the result of

  • Hormonal imbalance (excess of estrogen or deficiency of progesterone, or both - these imbalances are observed in particular at puberty or during the premenopause) ;
  • Uterine polyps (benign growths);
  • Early miscarriage;
  • Adenomyosis (a particular form of endometriosis affecting the uterus or the myometrium, i.e. the uterine muscle);
  • Endometrial hyperplasia or hypertrophy (increase in the volume of the lining of the uterus caused by hormonal imbalance);
  • A bleeding 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.

Women should be reassured that endometrial cancer is linked to very heavy bleeding in less than 1% of cases of menorrhagia.

What are the treatments for bleeding periods?

The treatment of menstrual bleeding depends directly on its cause. This is why the cause must be systematically 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, thus reducing the menstrual flow.

Taking a progestin-only pill, i.e. a low dose of progesterone, can also be considered. This contraceptive treatment will also regulate the growth of the endometrium. Another solution: a hormonal treatment in tablets, always based on progesterone, can be implemented. This treatment should be taken for 10, 15 or 20 days per month, but preferably for a short period of time because of the risk of associated meningioma (benign meningeal tumor). It is therefore to be preferred, for example, while waiting for a surgical intervention.

Ultrasound, a non-surgical treatment

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

Surgical treatments

Ovarian cysts, fibroids or uterine polyps may require surgery depending on their size, number and impact on menstruation. The same is true for adenomyosis or endometrial hypertrophy. Several surgical techniques exist.

Operative hysteroscopy

Also called gynecological endoscopy, operative hysteroscopy consists of operating inside the uterine cavity through the natural channels. The operation 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. This is because at this time the uterine mucosa is thinner. The surgeon's work is then easier.

For polyps or fibroids, operative hysteroscopy is only indicated if the tumor or tumors 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 procedure. The entire uterus is removed. The surgeon may also remove other organs, such as the cervix, ovaries, or fallopian tubes, during the same procedure. In women approaching menopause, only the ovaries are usually removed.

Patients may choose to have a 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 supply blood to fibroids or endometriosis lesions (in the case of adenomyosis, or endometriosis inside the uterus). It is used as an alternative to hysterectomy for women who wish to keep their uterus.

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

Why is it necessary to check your anemia regularly in case of menstrual bleeding?

Menstrual bleeding can cause iron deficiency anemia, i.e., a lack of iron. Iron is an essential element: it is used to produce red blood cells, which play an essential role in oxygen transport. That's why it's important tohave regular blood tests to check your health. If necessary, your doctor may prescribe iron supplements.

Iron deficiency anemia can cause fatigue, paleness, headaches, shortness of breath, dizziness or lightheadedness.

Menstrual panties 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, washable menstrual pants can hold the equivalent of 3 to 4 conventional tampons. They are thus particularly recommended in the event of hemorrhagic periods.

In addition to being effective (maximum absorption for the "hemorrhagic" range, sufficiently wide band to prevent the risks of leakage), the periodical panties are comfortable, but also refined.

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

At only two to three millimeters thick, Elia period pants are inconspicuous under your clothes. It's almost like wearing regular lingerie! Another great advantage: our entire collection is made of organic cotton. More respectful of the environment, the culture of organic cotton consumes 91% less water compared to traditional cotton. Wearing menstrual panties signed Elia, it is also to make a gesture for the planet!

The FAQ of hemorrhagic periods

When do we talk about bleeding periods?

Menstrual bleeding is characterized by very heavy bleeding (more than 90 ml), sometimes accompanied by clots, a flow that is difficult to control with conventional sanitary protection (tampons, pads, etc.) and an abnormally long duration (more than 7 days).

How to stop menstrual bleeding?

Menstrual flow can be reduced by taking non-steroidal anti-inflammatory drugs (NSAIDs), but only on medical advice and prescription. If you have a bleeding disorder, you may be prescribed anti-fibrinolytics.

How can you tell heavy periods from bleeding?

A heavy period is said to occur when the blood flow is between 40 and 90 ml. Beyond that, it is called a hemorrhagic period. To know the volume of menstrual blood in order to know if they have a heavy period or a hemorrhagic period, women can refer to the Higham score.

What are the remedies for menstrual bleeding?

Several solutions can be offered to women with bleeding periods, such as hormonal contraceptive treatment, ultrasound or even surgery (operative hysteroscopy, hysterectomy and uterine embolization).