Written By Endometriosis UK.
Discover how to manage heavy bleeding with endometriosis. We’ve got practical tips and insight into different treatment options to help manage this troublesome symptom.
Heavy menstrual bleeding also called menorrhagia is when the blood flow from a period is heavy and is affecting your daily life. You may need to change period products such as tampons, period pads and menstrual cups more frequently, every 1-2 hours. You may pass blood clots and may need to use 2 period products together to manage bleeding. You may notice leaking of blood onto underwear, clothes and bed sheets. For some periods may be prolonged, lasting longer than 7 days.
Endometriosis is a long-term condition where cells similar to the ones in the lining of the womb (uterus) are found elsewhere in the body. These cells can grow and change in response to hormones in the menstrual cycle, this can affect the uterus. Heavy menstrual bleeding is a commonly reported symptom of endometriosis. Not all with endometriosis will experience heavy periods, so you can have a lighter, shorter bleed and still have endometriosis.
Heavy and prolonged bleeding can be difficult to manage, here we provide tips and advice to support those with heavy periods and endometriosis.
The symptoms of endometriosis can vary from person to person, some may have severe and debilitating symptoms, others may have no symptoms at all. Symptoms are not always related to the location, amount or the type of endometriosis. Heavy periods are a symptom of endometriosis but that doesn’t mean everyone with endometriosis will experience heavy periods, you can still have endometriosis without heavy periods.
Endometriosis is a condition which is not fully understood, and more research needed. What we do know is that endometriosis can affect the whole body, it also causes an inflammatory response and pain. As endometriosis is most commonly found within the pelvis, pelvic organs, including the uterus can be affected, this can cause heavy periods. A related condition is adenomyosis, where cells similar to the ones in the lining of the womb grow within the muscle of the womb wall. The uterus is enlarged which may also contribute to heavier periods. Adenomyosis also responds to the hormones in the menstrual cycle. You can have only endometriosis or adenomyosis, although it’s quite common to have both.
Heavy menstrual bleeding is also a symptom of other health conditions, you may have heavy periods without endometriosis or adenomyosis.
There are treatments which can help manage heavy periods and endometriosis. Medications that either aim to stop periods or reduce the blood flow during a period can have a significant benefit for those struggling with heavy periods. Hormonal treatments are also used to help manage endometriosis. Hormone treatment such as the combined contraceptive pill or patch and progestogens, including the ‘minipill, norethisterone and the Mirena coil, prevent the endometrium (womb lining) from growing, shedding and bleeding. If the endometrium is exposed to progesterone for a prolonged amount of time it will become thin and inactive, this process aims to stop periods. For some periods may still happen, but they should be much lighter. The combined contraceptive pill and patch can be taken without a break to prevent a period.
Another type of hormonal treatment is Gonadotrophin Releasing Hormone analogues. These medications stop the ovaries from being stimulated stopping the production of oestrogen which prevents endometrium from growing. These medications cause a temporary medical menopause to stop periods and to manage endometriosis. Due to the menopausal effects of this medication there can be quite a few side effects including, hot flushes and mood changes.
Hormone treatments can have a contraceptive effect so should not be used if you are trying to become pregnant. However, not all hormonal treatments are licensed as contraceptives. It’s important you check the contraceptive licensing and use barrier methods if needed like condoms. A non-hormonal treatment for managing heavy periods is Tranexamic Acid, this medication doesn’t stop a period but controls the bleeding, making the flow lighter. It works on clotting and is usually only taken for 4 days from the start of a period.
Period products are also important for managing heavy periods. It’s important to find the period product that suits you best and that you find the most comfortable to use. You may want to look at the absorbency recommendation, products designed for heavier bleeding are usually best suited.
Living with heavy menstrual bleeding and endometriosis, either separately or together can be difficult and have a huge impact on daily life, especially around the time of a period. It’s important to recognise symptoms of endometriosis and heavy menstrual bleeding and speak to your GP or healthcare provider about these. Although heavy menstrual bleeding is a symptom of endometriosis it is also a symptom other health conditions. Your GP may investigate for other health conditions. Either way it’s important that symptoms are investigated and that you can access appropriate treatment.
Heavy periods and endometriosis may stop you doing or avoiding usual activities, like exercising or attending social events. You may be taking time off work because of your periods, you may be feeling fatigued and become short of breath. Heavy menstrual bleeding can lead to other health conditions such as anaemia (reduced red blood cells). Accessing care, investigations and treatments can make a big difference, so speak up and get the help and support that you need.
