Is it normal to have very heavy periods?

Q. I bleed heavily every month. Is there something I can do?

A. Heavy menstrual bleeding is very common, with approximately one third of women worldwide seeking treatment for it. The medical term is menorrhagia.

There are several symptoms that women may present:

• Bleeding that lasts more than seven days;
• Bleeding that soaks through one or more tampons or pads every hour for several hours in a row;
• Needing to wear more than one pad at a time to control menstrual flow;
• Needing to change pads or tampons during the night; and
• Menstrual flow with blood clots that are large and recurring.

Possible causes fall into the following three areas: uterine-related, hormonal, and other medical disorders. Non-cancerous uterine fibroids or polyps, endometriosis and polycystic ovarian syndrome, to name a few, are some of the common causes.

Cancer of the uterus or cervix is another important cause, and understanding one's risk factors as well as screening remain most important for early cancer diagnosis. Some forms of contraceptives, such as an intrauterine device, or IUD, may cause heavy periods.

If you are pregnant, conditions such as a spontaneous miscarriage or ectopic pregnancy can cause abnormal bleeding.

Certain medications, such as anti-thrombotic injections and tablets, can cause increased bleeding.

People have different perceptions of heavy menstrual bleeding. It is important to seek advice from your doctor or nurse who will ask you about your cycle and medical history.

Some gynecological conditions can be hereditary and your doctor may also ask if any of your family members have had heavy menstrual bleeding.

It is a good habit to track your periods by writing down the dates of your periods and how heavy you think your flow is (maybe by counting how many pads or tampons you use). This will be useful as you prepare for your consultation. You can expect a pelvic exam, ultrasound, pap smear, blood tests and other imaging investigations where appropriate

The type of management will depend on the cause of your bleeding, whether any complications have resulted and what your needs are regarding your menstrual cycle or pregnancy. It may include medical, surgical and supportive therapies.

• Dr Tlaleng Mofokeng (MBChB), sexual and reproductive health practice, Disa Clinic, safersex.co.za.

Do you have a question about sex?

E-mail your questions to lifestyle@sundaytimes.co.za with SEX TALK as the subject. Anonymity assured.