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Do you suffer from heavy menstrual bleeding?

If you lose a lot of blood for a few days at the start of your period, it may be normal. We've all leaked through a tampon or noticed a few blood clots on our pads at the end of the day. But if you have to change your sheets in the morning because you leaked overnight, don't wear light-colored clothes during your cycle, or stuff your bag with tampons or pads, you could be experiencing heavy menstrual bleeding (HBM).

What is “heavy menstrual bleeding”?

The medical name for heavy menstrual blood loss is menorrhagia, but the practical definition is when there is heavy menstrual blood loss that interferes with the physical, emotional, social and material quality of your life. Because every woman's periods are unique, it can be difficult to know if what you think is "normal" for your cycle is actually excessive bleeding. In fact, more than half of women who experience menorrhagia don't realize they have it. While the best way to know if you have HBM is to talk to your doctor, you can keep an eye out for some of the common symptoms of menorrhagia.

Common symptoms of HBM include

  • A short cycle
  • Bleeding for more than seven days
  • You lose so much blood that you have to change your sanitary towel/tampon regularly
  • You have to change your sanitary towel or tampon at night
  • You may need double protection to avoid leaking
  • You have clumps of blood that are bigger than a five cent coin or a bottle cap
  • Your period prevents you from doing the things you normally would
  • You have constant pain in your lower abdomen during your period
  • You are tired, have no energy, feel weak or dizzy or are short of breath
  • Blood leaks through your clothes

Causes of HBM

HBM can be caused by uterine problems, hormonal problems or certain medical conditions, such as adenomyosis, endometriosis, PCOS or clotting disorders. Other causes include:neoplasms or tumors of the uterus that are not cancer (myomas or polyps =common cause) and premenopause or perimenopause.

Some causes of heavy menstrual bleeding can be identified through research. In other cases no clear explanation can be found.

What treatment options are available for this medical condition?

Hormone Therapy (Pill or IUD)

Hormone therapy (the pill or a spiral) is often prescribed for heavy blood loss. These medicines can thin the lining of the womb and thus reduce menstrual blood loss. Hormone therapy is often a temporary solution, which means that alternative treatment is needed later. Because if you stop taking the pill or IUD, heavy menstrual blood loss usually returns.

MyoSure (scrape away myomas)

The MyoSure treatment is for women who suffer from heavy menstrual bleeding due to fibroids or polyps. This is only possible if you are not pregnant, do not suffer from pelvic infections or abnormalities of the cervix and if you do not have cervical cancer.

NovaSure (Endometrial Ablation)

In some women the endometrium is thicker than in others. A thicker layer generally means more blood loss during menstruation. Removal of the endometrium is then a proven way to reduce this heavy menstrual blood loss or even to stop the blood loss altogether

Dilation &Curettage (scraping away the uterine mucosa)

Dilation and curettage is a treatment in which the top layer of the endometrium is scraped away. This method uses, for example, a surgical instrument (curette) or a laser. The procedure is usually performed under general anesthesia.

Uterine Removal (Hysterectomy)

The most drastic method is hysterectomy, which sometimes has to be decided when there are no other solutions. For example with endometriosis, tumors, abnormal cells in the uterus, fibroids, pelvic floor problems and menstrual problems such as heavy blood loss. The procedure is performed under general anaesthetic, such as anesthesia or epidural. Hospitalization is required and the recovery period takes several weeks.

National campaign Blood serious

As many as 1 in 5 women experience heavy menstrual bleeding. In the Netherlands, this concerns about 500,000 women between the ages of 35 and 55. Because the majority of women continue to walk around with complaints, the Blood Serious campaign puts a dead serious health problem on the agenda. All year round and during the campaign month in November. The Blood Serious information campaign encourages women to discuss HMB (with each other and with the doctor) and offers tools for preparing a doctor's consultation. Everywhere in the Netherlands, hospitals organize extra consultation hours and other (online) events in November where extra information is given about HMB. Because 75% do not know that HMB is a medically recognized condition, 60% think that heavy periods are part of it, and 27% do not know how the GP could help with this. While there are several simple treatment options that can put an end to prolonged, painful and heavy periods. You can find everything about heavy menstrual blood loss, the solutions, the agenda for extra information and the campaign at