Is your menstrual flow abnormally heavy?
Do you need to change sanitary protection every two to three hours?
Even at night ?
Does the bleeding continue beyond seven days?
If the answer to these questions is "yes", it is very likely that you have heavy periods, also called "menorrhagia", or more rarely "hemorrhagic periods".
According to the National College of French Obstetrician Gynecologists (CNGOF), 10 to 35% of women are affected, and their care represents one third of the reasons for gynecological consultation.
In addition to harming the quality of life (including pain, chronic fatigue or anemia), heavy periods can be a symptom of a health concern, and should be the subject of medical concern.
Read alsoLate periods, irregular cycles… When should you consult?
Colonized walls
Each month, and for each woman, if no pregnancy occurs, the upper layer of the endometrium (or uterine lining) disintegrates and bleeds: these are the periods.
An abnormality in the morphology of the uterus can cause heavy periods.
"The presence of one or more polyps
(glandular growths, editor
's note) or fibroids
(uterine abnormalities, editor's note)
deforms the uterine cavity, which makes the endometrium more friable and causes these abundant losses", explains Giulia Gouy, medical gynecologist at the Croix-Rousse hospital in Lyon, working in a department specializing in this care pathway.
These tumors, benign according to the doctor, are detected via a pelvic ultrasound, an examination systematically recommended for menorrhagia.
Another common culprit of heavy periods, also detected by imaging: hormonal imbalance.
It causes a thickening of the endometrium, or hypertrophy, and will increase the volume of losses.
"Tobacco, obesity and age are risk factors," notes Dr. Giulia Gouy.
Women in perimenopause may thus notice an increase in menstrual flow.
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The presence of one or more polyps or fibroids deforms the uterine cavity, which makes the endometrium more friable and causes these abundant losses
Giulia Gouy, medical gynecologist at the Croix-Rousse hospital
Sometimes, the endometrium goes so far as to colonize the uterine muscle and cause adenomyosis, or endometriosis inside the uterus.
Can it lead to deep form?
No, replies the gynecologist.
"It has been noticed that patients with endometriosis have heavy periods but for the moment, we have not determined a cause and effect," she adds.
Finally, the case is rare but abnormal uterine bleeding can be associated with endometrial cancer.
"From the age of 40, women prone to heavy menstruation should consult to rule out this risk," says Dr. Giulia Gouy.
Read alsoEndometriosis, the unmistakable symptoms
In video, "Bon Sang", a series on the rules
A bleeding disorder
When the gynecological cause of heavy periods is not identified (in the majority of cases), health professionals explore the blood trail.
According to Sophie Susen, professor of hematology and head of the Haemostasis-Transfusion department at the University Hospital of Lille, one in five women who complains of heavy periods reveals a bleeding disorder.
“It's a symptom of an inherited defect, most commonly Willebrand's disease or a blood platelet disorder.
But the taboo that surrounds menstruation in the family delays the diagnosis and very often, we only happen to detect it in the preoperative assessment or during a pregnancy, ”laments the hematologist.
However, if it is not diagnosed, this pathology causes bleeding of different intensities, in the nose, during a trauma and more rarely in the joints.
How do I know if I have heavy periods?
To target the needs of each patient, health professionals rely on the Higham score.
This tool takes the form of a table and calculates the abundance of rules.
Women are invited to evaluate their protections used on a daily basis, judging the aspect (little to very soaked) and noting the number used.
"When it's over 100, treatment is necessary," said Giulia Gouy, medical gynecologist.
But this is not the only indicator, the patient's complaint must also be taken into account in this diagnosis, reports the CNGOF.
Taking medication is also enough to produce heavy periods.
“Anticoagulant treatment can be given to women in case of phlebitis, pulmonary embolism or heart rhythm disorders.
But in some, it promotes the onset of bleeding, ”underlines Professor Sophie Susen.
This is why the specialist strongly encourages colleagues and patients alike to raise the subject of heavy periods in medical consultation.
Possible treatments for heavy periods
To improve the diagnosis, the Croix-Rousse hospital is the first establishment to launch in December 2021 a consultation dedicated to heavy periods.
For three hours, the patient undergoes a pelvic ultrasound, a blood test and meets with specialists.
In the absence of such a structure in geographical proximity, the women concerned are invited to consult a health professional, such as a medical gynecologist specialized in female endocrinology and a doctor specialized in bleeding disorders.
One in five women who complain of heavy periods reveal a bleeding disorder
Sophie Susen, professor of hematology, head of the Haemostasis-Transfusion department at Lille University Hospital
As a rule, management begins with symptomatic treatment.
“The doctor prescribes an antifibrinolytic such as tranexamic acid, a medicine used in the treatment of haemorrhages to reduce the volume of bleeding.
He also prescribes analgesics to treat pain and iron supplementation to counter anemia,” reports Sophie Susen, professor of hematology.
The rest of the medical support is adapted according to the situation of each patient.
If a fibroid or a polyp is detected on ultrasound, this requires, depending on the situation, surgical removal or drug treatment, reports gynecologist Giulia Gouy.
And when the blood test reveals a hereditary hemorrhagic disease, the hematologist addresses a specific treatment for the bleeding disorder, generally injected intravenously, says Dr. Sophie Susen.
Read alsoThe truth about eleven received ideas surrounding the IUD
In case of proven hormonal imbalance or unidentified gynecological cause, taking hormonal treatment (pill or IUD) is recommended.
“A copper IUD increases mucosal inflammation and promotes heavier and more painful periods.
Hormonal contraception will on the contrary attenuate this process, by acting on the problematic thickening of the endometrium.
Thus, it regulates the cycle”, details the gynecologist, inviting not to “demonize the pill”.
Finally, for patients who do not wish to keep their uterus and/or who have no desire for a child, a hysterectomy may be considered.
