Having a very heavy period can be troubling and frustrating. It can be hard to manage the amount of bleeding, particularly if you have to change your tampons or pads very often or have flooding for days and you are not feeling well.
Understanding what is happening is important so that you know what to expect and when you should talk to your Haemophilia Treatment Centre or seek medical assistance.
What is heavy bleeding?
• Soaking through a tampon and a pad around every two hours or more often, or needing to change protection during the night.
• Periods for longer than normal (longer than 8 days)
• Bleeding with clots bigger than a 50 cent piece
• Bleeding or spotting between periods.
Spotting can sometimes happen mid-cycle, at the same time every month, but in women with a bleeding disorder this can sometimes last several days and require pads or tampons. Keep a diary. It is also worthwhile having this checked by your local doctor. Sometimes there can be other causes that need to be checked and they may need to refer you to a gynaecologist.
• Flooding (soaking through tampon or pad through clothes or onto bedsheets)
Why am I feeling like this?
During your period, your hormone levels change and the prostaglandins and other special chemicals that tell your body to peel off the lining of your uterus and start the bleeding can affect how you feel. They can make you feel dizzy and faint, they can cause nausea (feeling like you are going to be sick), vomiting and diarrhoea, give you cramping pain, and make you feel like you don’t have any energy and make you look pale.
It is unusual for a single heavy period to cause anaemia - usually it happens over months to years. If you often have heavy periods, the iron levels in your blood can gradually drop. This causes anaemia which in turn can make you look pale and feel really tired and dizzy and breathless, particularly if you are doing something a little bit strenuous like walking up stairs. It is very important to visit your GP - to have your blood and iron levels checked and to replace the iron in your body. You also need to deal with the heavy menstrual bleeding which is causing your low iron levels.
You might be feeling alarmed at the amount of blood you are losing during a single heavy period but your body is able to quickly replace it. Throughout one heavy period, you could easily lose more than 80ml of blood (around a third of a cup) and sometimes much more over several days. That might seem like a lot but, if you are around 50-65kg, your body has around 4.5 - 5.5 litres of blood which it constantly replaces. By comparison, a blood donation usually takes about 10% of the donor’s blood, or around 450 – 550 ml in one day.
Who should I talk to?
Seeing your GP can be a good place to start. They can take care of other aspects of your health including doing a general Women’s Health check. If you are not already being managed by your Haemophilia Treatment Centre for heavy bleeding, talk to your doctor about making an appointment with them when you feel better.
Your Haemophilia Treatment Centre will discuss the bleeding symptoms with you, and may also want to test your blood to check your iron levels. If needed they can put some management strategies in place and may want to refer you to a gynaecologist for specialist care. Your gynaecologist will be part of your medical care team, and will work together with you and your haemophilia team to understand and manage your bleeding symptoms. Not all gynaecologists are familiar with treating people with mild bleeding disorders and sometimes it is necessary to change doctors to find one who will listen to your concerns.
When should I seek help?
If you have very heavy bleeding, and ongoing and very noticeable symptoms of dizziness or extreme tiredness or breathlessness then it is important to seek medical help urgently. Medical staff need to check for and treat anaemia and start medical treatment to slow the bleeding. You should seek advice from your Haemophilia Treatment Centre about the best place to go (such as which hospital) depending on your individual situation and where you live.
In some situations, this may need to be the Emergency Department. This is so that a quick medical assessment and blood tests can be done and treatment can be started in consultation with the Gynaecology and Haematology specialty doctors on call for the hospital. If you do need emergency treatment for extremely heavy periods it is important to let the Emergency Department doctor know about your bleeding disorder and show them your ABDR treatment card so your haematologist is contacted for advice.
Most of the time however, heavy periods are not an emergency and can be managed at home. If you are feeling nauseous, fatigued or have cramping pain during your heavy period, it is important to look after yourself. Take the time to rest, drink plenty of water and take pain relief if you need it to feel more comfortable. Sometimes a hot water bottle can provide comfort for cramping pains.
If you are still bleeding heavily after 8 days, or if you are still feeling faint and dizzy or have no energy to the point where you can’t do your normal daily activities (such as go to work or to school), and are still worried make an appointment with your GP. If you do faint and hit your head, make sure you are taken to hospital right away to check if there is bleeding inside your head that can put pressure on your brain.
Contact details of Haemophilia Treatment Centres in Australia are available on the HFA website.
For more information on bleeding disorders in young women read our full Female Factors resource
Answered by: Doctor