Coping with Heavy Bleeding - Day and Night

By Dannielle Stewart

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Heavy bleeding is a common symptom for those experiencing adenomyosis and endometriosis, and is also associated with other gynaecological conditions such as uterine fibroids. It can be an incredibly frustrating, embarrassing and exhausting symptom to cope with. 

Menorrhagia is the medical term for abnormally heavy or prolonged menstrual bleeding, whereas dysfunctional uterine bleeding is defined as excessively heavy, prolonged or frequent bleeding from the uterus that is not due to pregnancy or any diagnosed pelvic pathology. Both may require investigation and management by a gynaecologist to improve quality of life and identify problems that may require treatment. If you are experiencing heavy, prolonged bleeding for any reason, consult your GP and/or gynaecologist for assessment. 

Sufferers of adenomyosis in particular may complain of heavy menstrual periods and episodes of “flooding” where bleeding is so significant that the person may overflow heavy absorbency pads or tampons, or wake to find they have bled onto bedding. This bleeding may also be accompanied by clotting. Consistently heavy bleeding can cause anaemia and individuals may find themselves experiencing fatigue, shortness of breath on exertion, dizziness and heart palpitations. It’s easy to become exhausted and overwhelmed by the mental labour associated with coping with such a symptom. 

How Much Is Too Much? 

While everyone is different, a “normal” blood loss is considered to be, on average, 6 to 8 teaspoons with 80ml considered the upper level of normal. Bleeding over 80ml each period or having a period more than 7 days long, or both, is considered to be a diagnosis of menorrhagia. Additionally the Royal Australian College of GPs highlights that an assessment of bleeding should consider the following factors: bleeding or flooding not contained within pads or tampons (particularly if using larger sizes), clots greater than 3cm and clinical signs of iron deficiency anaemia. 

So how do you know if your bleeding is normal? Keeping track of your bleeding is a good place to start. You can use the QENDO app to track both cyclical bleeding and any other kind of bleeding such as spotting or breakthrough bleeding. If you are taking hormonal contraception, including the oral contraceptive pill or IUD, you may experience breakthrough bleeding, especially when you first start using these - incidence generally declines over time and with consistency. You can track bleeding patterns, heaviness of flow, colour of bleeding, and length of bleeding. You can present this information to your healthcare team to help them in assessing you. 

Key point to remember:  if you’re consistently tracking heavy bleeding, bleeding that lasts more than 7 days each cycle, and clots - these are symptoms that need professional assessment. 

Management Strategies for Heavy Bleeding 

There are many interventions a doctor may suggest to help relieve heavy bleeding, talk with your healthcare team about which might be right for you, based on your other symptoms. Interventions may include medications, surgical intervention for diagnosed conditions, and hormonal treatments. The appropriate treatment will vary for each individual and you are in charge of your healthcare journey - seek a second opinion if you’re not comfortable with the options presented to you. 

Medications to reduce bleeding 

• Non-steroidal anti-inflammatories (NSAIDs)

  • These act by reducing prostaglandin levels which can be excessive in heavy menstrual bleeding. Prostaglandins are also contributors to cramping, thus NSAIDs may reduce pain as well as bleeding 

  • Heavy flow has been shown to be reduced by up to 30% with a number of common NSAIDs. Mefenamic acid (Ponstan) is often preferred for heavy menstrual bleeding. These are contraindicated in those with gastrointestinal problems, ulcers, or asthma and may not be effective for everyone.

• Tranexamic Acid (TXA)

  • Antifibrinolytic agent, this means that it reduces bleeding by acting on the enzymes in the blood that contribute to bleeding and clotting, in order to reduce bleeding. It’s often prescribed for use on the heaviest day of your period - another reason why tracking symptoms is helpful 

• Hormonal contraception 

  • Oral contraceptive pill, Mirena IUD, Implanon 

  • These medications reduce bleeding by inducing a thin endometrial lining, they may also reduce the symptoms of dysmenorrhea that occur with endometriosis and adenomyosis 

  • OB/GYN Dr Graham Tronc notes that if you have not yet received a diagnosis, it is not good enough to simply be prescribed the contraceptive pill with no further assessment and investigation of symptoms, as the pill may mask symptoms of endometriosis and adenomyosis, particularly in adolescents. 

  • In adenomyosis a Mirena IUD may be utilised to deliver more progestogen to local tissues in the uterus - some people will still experience systemic side effects, tolerance is dependent on an individual’s symptoms and preference. An IUD is not for everyone but can be an effective treatment for some. 

  • The pill can have side effects that differ for each individual, speak to your healthcare team if you’re concerned about the effect it is having or if you want more information about how you can support your health holistically while taking the medications necessary for your individual circumstances. E.g. working with a dietician to ensure adequate intake of nutrients that can be depleted by contraceptive use.

• Progestogens and GnRH Agonists 

  • Medications such as Primolut may be prescribed either alone or in addition to contraception for patients who have persistent heavy bleeding despite treatment

  • Zoladex or Synarel may be prescribed for those with endometriosis and adenomyosis for a number of persistent symptoms including bleeding - both can be effective, but it is a short term therapy and some patients may experience side effects that are problematic. Zoladex is not a cure for endometriosis or adenomyosis, but some patients experience relief, particularly with persistent pain and bleeding 

Surgical Options 

• Excision surgery for endometriosis 

• Uterine artery embolisation for uterine fibroids 

• Minimally invasive surgical techniques for removal of fibroids

• Ablation of the endometrium (not appropriate for those who wish to have children)

• Hysterectomy for adenomyosis - as a last resort when other modes of treatment have failed. Note a hysterectomy is NOT a cure for endometriosis 

• All surgical options must be discussed with an expert in the field, with the right experience. You can use the QENDO referral list to find the right practitioner for you. Don’t be afraid to seek a second opinion.

Coping With Your Flow - Beyond Pads and Tampons 

As part of development for our app, we talked to a lot of people in the chronic illness community, and one of the questions we asked was about how YOU cope with heavy bleeding. We received a huge variety of coping strategies, from wearing maternity pads, multiple pads or even adult nappies to prevent leakage onto clothing, to sleeping with a towel to correct mishaps with sheets. Purchasing pads and tampons can become expensive if you have to utilise a lot of them, especially if you’re trialling new management strategies, and some people experience discomfort from frequently changing full sanitary products that come with heavy bleeding. 

Here are some other options for coping with you bleeding, based on feedback from our QENDO community! 

• Menstrual cup 

• Re-usable pads 

  • Eco Pads, Hannah Pad 

  • Sustainable, washable, appropriate for those who experience irritation from synthetic pads 

• Period Underwear

  • ModiBodi, Thinx, Libra

  • Different absorbancies depending on how heavy your flow is, may be less bulky than pads, and are more sustainable 

• Protective Bedding 

  • Peachy Keen Bed Mate 

  • No more towels on your bed, the Bed Mate Sheet Saviour is waterproof and absorbable, and designed to fit in with your bedding to prevent flooding accidents. 

Keep in contact with your healthcare team - if you’re worried about the amount of bleeding you’re having or recurring symptoms such as fatigue and dizziness, check in with your doctor and have your bleeding assessed. Keep track of your symptoms and monitor any changes, you are in control of your health and your body. 

References 

Farrel, E. Dysfunctional uterine bleeding. Australian Family Physician, 2004, Vol 3. No.11: 906-908.

Foran, T. The management of irregular bleeding in women using contraception. Australian Family Physician, 2017, Vol 46, No 10: 717-720. 

Walker, Graeme. Heavy menstrual bleeding. Gold Coast Private University Hospital, 2019.