Dysfunctional Uterine Bleeding (DUB) is defined as irregular and heavy menstrual bleeding in the absence of any uterine or pelvic disease and can affect up to 30% of women in their lifetime.  A normal menstrual cycle has a frequency of 24 to 38 days and lasts between 2 to 7 days, with 5 to 80 mls of blood loss. There are 2 types of DUB depending on the age when the symptoms presents;

• Anovular DUB occurs in 2 extreme age groups namely adolescence (just as periods has started at menarche) or peri-menopause (just as periods is about to end around the time of menopause).  The cause is due to hormonal changes during this period of time
• Ovular DUB is found in women between 35-45 years old due to an organic cause such as defective corpus luteum formation or reproductive tract disease

Click to view JeanHailes video on Heavy Periods

Management

Do keep a diary of your bleeding and non-bleeding days and take note of how heavy your flow was and how much sanitary pads or tampons you needed to control it on a single day.  ALL cases of heavy menstrual bleeding should be seen by a gynaecologist so that you can get a thorough check up and get some of these tests done.

• Blood tests (to check for anaemia or clotting disorders)
• Hysteroscopy
• Cervical Cancer Screening test (Pap smear)
• Tissue biopsy (to exclude cancer)
• Ultrasound scan

Treatment for Heavy Periods

Treatment depends on many factors (such as the need for contraception or for surgery) which you can discuss with your doctor.  Medication is usually the first-line of treatment to preserve fertility as well as to avoid surgery unless necessary.  These options include

A. 1st line Medication

• Tranexamic Acid (used for 3-5 days) can reduce the heaviness by 50%
• Non-Steroidal Anti-Inflammatory Drugs (NSAID) such as Mefenamic Acid
• Contraceptive pills such as Progesterone OCP
• Levonorgestrel-releasing IUCD (such as Mirena)
• Depo-Provera

B. 2nd line Medication

• Danazol (inhibits pituitary gonadotrophin hormone)
• GnRH Analogue
• Ethamsylate

C. Surgical Options

• Endometrial Ablation (to preserve fertility for future pregnancy)
• Hysterectomy (definitive and most effective) is usually reserved for failed medication treatment or for women who do not have plans for more children (or are menopausal)

Discuss with your Gynae Doctor about your treatment options

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If you think you may be suffering from any medical condition, you should seek immediate medical attention from your doctor or other professional healthcare providers. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.