The causes of irregular and heavy periods

By Mr Ertan Saridogan, Consultant Gynaecologist
University College Hospital London, Portland Hospital for Women and Children
Published June 9th, 2011  |  Last updated March 27th, 2012

What are the causes of irregular and heavy periods?

Irregularity and heaviness of periods may be due to a number of causes including fibroidsBenign tumours, most often in the uterus. (non-cancerousMalignant, a tumour that may invade surrounding tissues or spread to distant parts of the body. growths) of the wombThe uterus., polypsGrowths on the surface of a mucous membrane (a surface that secretes mucous), lining any body cavity that opens to the outside of the body. (abnormal growth of tissueA group of cells with a similar structure and a specialised function. from the lining of the womb), thickening of the lining of the womb (hyperplasia), adenomyosis of the womb (non-cancerous condition of the womb that often mimics the symptoms of fibroids), bleeding or clotting problems, bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. thinning medication, hormonal imbalance or, very rarely, cancer of the womb or of the neck of the womb (cervixAny neck-like structure; most commonly refers to the neck of the uterus.). I will discuss these conditions below.

Contents

What are fibroids?

Fibroids (also known in medical terms as myomas or leiomyomas) are benignNot dangerous, usually applied to a tumour that is not malignant. (non-cancerous) lumps of smooth muscleA type of muscle responsible for actions in the body that we are not aware of; for example, the muscles that constrict blood vessels. which grow from the wall of the womb. They are very common and on average are found in 20-30% of women during their childbearing years. They are more frequently found in older women and by the time a woman reaches the age of the menopauseThe time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle., her risk of having a fibroid is around 70-80%. However, the majority of fibroids are harmless and often do not cause any symptoms.

Fibroids are more likely to cause heavy and irregular periods when they are located inside the cavity of the womb or protruding into it.  These fibroids are called submucosal fibroids and even when they are small they can cause heavy period bleeding, bleeding in between periods or completely irregular, erratic cycles. These symptoms may also be caused when the fibroids are very large, or when there are many fibroids causing significant enlargement of the womb. These fibroids may be completely located in the muscle layer of the womb (intramural fibroids) or grow outwards from the surface of the womb (subserosal fibroids).

What are polyps?

Polyps are ‘skin-tags’ that grow from the lining or neck of the womb. They are benign growths, which means that they are harmless, and they are extremely common.  Large polyps may cause heavy and/or irregular periods.  Smaller polyps may be less likely to cause heavy periods but they may still cause bleeding in between periods.  Polyps of the neck of the womb may cause bleeding after sexual intercourse.

What is abnormal thickening of the lining of the womb?

The medical term for abnormal thickening of the lining of the womb (the endometriumThe layer of tissue lining the uterus.) is hyperplasia. The lining of the womb is normally very thin immediately after a period and it gradually thickens towards the middle of the cycle under the influence of the hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. oestrogenA hormone involved in female sexual development, produced by the ovaries..  After the ovulationWhen one or more eggs are released from the ovary. (release of the egg), the thickening comes to an end, and this is controlled by the hormone progesterone. The lining of the womb then sheds as a period. Abnormal thickening of the lining of the womb (endometrial hyperplasiaA condition in which there is an abnormal increase in the cells lining the uterus (endometrium). Some types may progress to uterine cancer.) usually occurs when there is a hormonal imbalance that results either in dominance of the oestrogen hormone or in the absence of the progesterone hormone. Typical examples of these conditions include women who do not ovulate due to ‘polycystic ovary syndromeA hormonal disorder characterised by scanty or absent periods.’ and overweight/obese women who produce excessive oestrogen hormone in their adipose (fatOne of the three main food constituents (with carbohydrate and protein), and the main form in which energy is stored in the body.) tissue.  In these situations, the lining of the womb is stimulated by the oestrogen hormone constantly, resulting in the abnormal thickening, without the protection of the progesterone hormone.  Thickened lining may shed from time to time, causing an irregular pattern of bleeding which tends to be quite heavy.  

In addition, certain types of thickening can progress to cause abnormal changes of some cells (this is called atypia) and this carries a risk of developing into cancer of the lining of the womb (endometrialRelating to the endometrium. cancer) in some women. In these circumstances abnormal changes to cells is considered a pre-cancerous condition.

What is adenomyosis?

Adenomyosis is a condition where tissue from the lining of the womb is found in the muscle layer of the womb.  It is similar to endometriosisA condition in which tissue that normally lines the uterus (womb) of a woman is found outside the uterus or in other parts of the body. but in endometriosis the tissue from the lining of the womb is located outside the womb.  Adenomyosis causes bleeding in the muscle layer of the womb every month when a woman has a period. This bleeding results in thickening of the wall of the womb, with small pools (cysts) of blood collection in the muscle layer.  As a result, women with adenomyosis have enlarged wombs and may experience heavy and painful periods. Adenomyosis and endometriosis may sometimes be found together. 

Heavy periods caused by blood-clotting disorders

Some women may have excessive blood loss during their periods due to problems in their blood-clotting system. These problems are usually due to geneticRelating to the genes, the basic units of genetic material. disorders and the women who have them also usually have a history of bruising very easily and prolonged bleeding from minor cuts.  (One example of this sort of condition is von Willebrand Disease (vWD). Women suffering from these problems tend to have heavy periods starting in their teenage years.

Heavy periods caused by blood thinning medication

Some women may have heavy periods because they might be using blood thinning injections (such as heparinA substance produced by the body, or given as medication, that reduces the likelihood of the blood to clot, coagulate.) or tablets (such as warfarinAn anti-coagulant drug used to treat and prevent abnormal blood clotting.).  These drugs are used for prevention of thrombosisThe formation of a blood clot. in certain situations, for example in women with artificial heart valves, with history of thrombosis.

Heavy periods caused by hormonal disorders

Women who do not ovulate (release an egg) regularly tend to have irregular periods. Typically this occurs during the teenage years, the pre-menopausalRelating to the menopause, the time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle. years (years leading up to the menopauseThe time when a woman's periods permanently cease.) and in women with polycystic ovary syndrome.  In these situations, lack of ovulation leads to irregular shedding of the lining of the womb and sometimes thickening of the lining (see hyperplasia section above) and this causes irregular and sometimes heavy periods.

Cancer of the womb/neck of the womb

Cancers of the womb and the neck of the womb are rare in childbearing age women who have regular smear tests.  Cancer of the womb is more commonly seen in women after the menopause, but can occasionally occur in women with severe polycystic ovary syndrome and obesityExcess accumulation of fat in the body..

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Expert articles by Mr Ertan Saridogan

Irregular and Heavy Periods

By Mr Ertan Saridogan, Consultant GynaecologistContact
University College Hospital London, Portland Hospital for Women and Children

Irregular and heavy periods are amongst the most common gynaecological problems that trouble women during their childbearing years.  Published studies report that between 4% and 50% women suffer from heavy periods; this large variation is probably due to cultural differences and the way that ‘heavy periods’ are defined or measured. However, it is likely that approximately one in eight to ten women experience heavy periods.

Medical investigations and treatment for irregular and heavy periods

By Mr Ertan Saridogan, Consultant GynaecologistContact
University College Hospital London, Portland Hospital for Women and Children

When a woman with heavy and/or irregular periods sees a doctor the first step will be the taking of a detailed medical history. Important aspects in the history are age, the duration of the problem, the length of the cycles and duration of bleeding, whether there are associated symptoms such as pain, whether contraceptives or precautions are used to prevent pregnancythe period from conception to birth, the history of smear tests and the possibility of pregnancy. 

Endometriosis: Latest treatment options

By Mr Ertan Saridogan, Consultant GynaecologistContact
University College Hospital London, Portland Hospital for Women and Children

Endometriosis is defined as the presence of tissueA group of cells with a similar structure and a specialised function. or cells from the lining of the wombThe uterus. (endometriumThe layer of tissue lining the uterus.) elsewhere in the body. It is most commonly found around the uterusThe womb, where embryo implantation occurs and the growing foetus is nourished. and ovariesFemale reproductive organs situated one on either side of the uterus (womb). They produce egg cells (ova) and hormones in a monthly cycle., but it can be located anywhere in the body except the spleenAn organ situated on the left side of the abdomen that filters out worn-out red blood cells and other foreign bodies from the bloodstream.. In the ovary endometriosisA condition in which tissue that normally lines the uterus (womb) of a woman is found outside the uterus or in other parts of the body. can form cysts containing old bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid., also known as chocolate cysts (endometriomaA cyst that is formed when endometrial tissue, the membrane that makes up the inner layer of the uterine wall, grows in the ovaries. ) due to the colour of the contents. When it is in the pelvisThe bony basin formed by the hip bones and the lower vertebrae of the spine; also refers to the lower part of the abdomen. it may affect the bowelA common name for the large and/or small intestines. and the urinary tractThe channels that carry urine from the kidneys to the outside of the body. (bladderThe organ that stores urine. and kidneys). Occasionally it is found in the navel or operation scars. When the tissue from the lining of uterus is found in the muscleTissue made up of cells that can contract to bring about movement. layer of the uterus it is called adenomyosis. Sometimes endometriosis and adenomyosis can be found together in the same woman.

Expert articles

Uterine Fibroids FAQs

By Mr Adrian Lower, Fibroids ExpertContact
The Princess Grace Hospital

Following the series of articles about uterine fibroidsBenign tumours, most often in the uterus. by Consultant Gynaecologist, Mr Adrian Lower, many women have written us questions. These have now been answered by Mr Lower in his article on the most frequently asked questions on fibroids.

What is involved in Uterine Fibroid Embolisation (UFE)?

By Dr Nigel Hacking, Consultant RadiologistContact
Southampton University Hospitals NHS Trust, The Princess Grace Hospital

Uterine Fibroid Embolisation (UFE) is a non-surgical, minimally-invasive, procedure that blocks off the arteries that supply the fibroidsBenign tumours, most often in the uterus. with bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. (the uterine arteries), therefore shrinking the fibroids. It is performed by an interventional radiologistA doctor specializing in the interpretation of imaging techniques for the diagnosis and assessment of disease. with the patient sedated and results in shrinkage of fibroids by an average of 60%.

Modern Management of Uterine Fibroids

By Mr Adrian Lower, Fibroids ExpertContact
The Princess Grace Hospital

In the earlier articles in this series we looked at the nature of fibroidsBenign tumours, most often in the uterus. and the investigations used to establish an accurate diagnosisThe process of determining which condition a patient may have..  In this article we shall look at the management options for the treatment of uterine fibroids and some of the factors which will guide your gynaecologist in helping you to select the correct management for you.

Investigations used to establish a diagnosis of uterine fibroids

By Mr Adrian Lower, Fibroids ExpertContact
The Princess Grace Hospital

Symptoms attributable to uterine fibroidsBenign tumours, most often in the uterus. can also be caused by a number of other conditions, notably ovarianrelating to the ovaries cysts, endometriosisA condition in which tissue that normally lines the uterus (womb) of a woman is found outside the uterus or in other parts of the body. and pelvicRelating to the pelvis. infectionInvasion by organisms that may be harmful, for example bacteria or parasites..  As such, it is particularly important that the most appropriate investigative technique is used to determine an accurate diagnosisThe process of determining which condition a patient may have. and subsequent options for treatment.  

An Introduction to Fibroids

By Mr Adrian Lower, Fibroids ExpertContact
The Princess Grace Hospital

Uterine fibroidsBenign tumours, most often in the uterus., which are non-cancerousMalignant, a tumour that may invade surrounding tissues or spread to distant parts of the body. tumours, occur in up to 50% of women.  Although they only cause symptoms in around a quarter of cases they remain the most common cause of hysterectomyThe surgical removal of the uterus (womb). before the menopauseThe time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle..

Recent news

Endometriosis treatment must meet needs of patient

Total Health | April 11th, 2012

One of London’s lead gynaecologists has warned that a ‘one size fits all approach’ is no longer appropriate for treating women diagnosed with endometriosisA condition in which tissue that normally lines the uterus (womb) of a woman is found outside the uterus or in other parts of the body.. The patient’s symptoms, expectations and circumstances all need to be taken into account and discussed with the multidisciplinaryRelating to a group of healthcare professionals with different areas of specialisation. team (MDT), as well as with the patient before options are considered.  For example, if the endometriosis has been found incidentally or as part of a screen and there are no symptoms, then no treatment may be needed at all.  

New treatments for fibroids

Total Health | March 21st, 2012

Traditional treatments for uterine fibroidsBenign tumours, most often in the uterus. include hysterectomyThe surgical removal of the uterus (womb). and hormonal drugs but a wide range of innovative treatments are currently in use or are currently being tested. Uterine fibroids are benignNot dangerous, usually applied to a tumour that is not malignant. growths in the wombThe uterus. and are the most common non-cancerousMalignant, a tumour that may invade surrounding tissues or spread to distant parts of the body. growths in women of reproductive age.

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