Abnormal vaginal bleeding

Heavy bleeding is more common in women who have just started their periods or are coming up to menopause. Symptoms of heavy bleeding include:

• having to change tampons or pads many times a day
• avoiding going out for fear of an “accident” (flooding)
• having large clots
• having to get up in the night to change pads.

Bleeding that is not a normal period could be caused by:

• hormonal changes (such as starting menopause or polycystic ovary syndrome)
• endometrial polyps
• contraception such as the pill, injection, implant or IUD (intrauterine device)
• infection in your vagina or uterus
• fibroids or polyps inside your uterus
• trauma to your vagina
• some medications such as anticoagulants
• underlying health problems such as bleeding or thyroid disorders
• cancer in the lining of your uterus, your cervix or vagina (this is rare).

There is a wide range in what is 'normal' for periods. They can last from 3 to 10 days, and happen every 3 to 6 weeks. Variations can be caused by age, stress, diet, exercise and other medical conditions.

See your healthcare provider if:

• you have bleeding between your periods
• you are worried about abnormal bleeding
• your periods have changed, especially if you have more frequent or heavier bleeding
• you have bleeding after sex
• you have been through menopause (no longer have periods) and have any bleeding.

If you are not sure what to do call Healthline 0800 611 116

Your healthcare provider will examine you and and may carry out an internal (vaginal) exam. They will also check your medical history. You may need some tests, including:

• cervical screening
• pregnancy test
• blood tests
• ultrasound
• endometrial sampling (a small tube like a straw is passed through the cervix and the lining of the uterus is gently collected by suction)
• dilation and curettage (gently widening the cervix and scraping away the lining of the uterus)
• hysteroscopy (the lining of the uterus is viewed with an instrument).

A dilation and curettage, and hysteroscopy will be done under anaesthetic. The 2 tests may be done together.

Treatment for the bleeding depends on what has caused it, but may include:

• anti-inflammatory drugs
• antibiotics
• change of contraception
• hormone therapy, including slow release implants
• medicines to block the breakdown of blood clots to prevent bleeding, such as tranexamic acid
• surgery to remove fibroids, polyps or cancer
• treatment for any underlying health problem.

Women with heavy periods (menstrual bleeding) because of large uterine fibroids may choose to have one of these treatments after talking to their healthcare provider:

Fibroid embolisation

This is a non-surgical method of treating fibroids by blocking the arteries that feed the fibroid. Patients stay in hospital overnight and generally go home the following day.

LINK TO Fibroid embolisation [page to be written]

Myomectomy

In this procedure fibroids are removed but the uterus is saved. This can be done by hysteroscopy, laparoscopy (key-hole surgery) or laparotomy (cut in abdomen). The type of surgery depends on the position and size of the fibroids. You will be able to discuss options with the gynaecologist. 

Hysterectomy

Hysterectomy is major medical procedure when your uterus is removed. This means your periods stop permanently. There are more side effects and recovery takes longer. This is only recommended if other methods to control the bleeding have been unsuccessful.

If you have abnormal bleeding make sure you:

• get plenty of sleep
• eat a well-balanced diet
• do some gentle exercise
• keep a diary of your symptoms to show your healthcare provider.

If you have pain with your bleeding:

• rest — curl your knees up to your chest and lie on your side
• place something warm on your tummy, like a hot water bottle or wheat bag
• rub or massage where it hurts
• take painkillers such as paracetamol or ibuprofen — avoid aspirin
• try relaxation techniques.