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  • Dr Peter Chew

Heavy menses

Q. I am 35 years old with 2 children. For the past 6 months, my menses are getting very heavy with the passage of large blood clots.  Is it normal? What are the causes? I consulted my family physician, who gave me iron supplements. How does iron help?A. If you notice a change in the amount of menstrual bleeding and pass out large blood clots, you probably realise  that something is not right.There are many causes of heavy menses. Common causes include:  


Hormonal  imbalance. In a normal menstrual cycle, there is a balance between 2 hormones secreted by the ovary, namely oestrogen and progesterone. These hormones regulate the lining of the womb (endometrium), which is shed during menstruation. If hormonal imbalance occurs -which may be due to the ovary not producing and releasing the egg (anovulation), the endometrium grows in excess and finally sheds by way of heavy bleeding.


Uterine fibroids. These are common noncancerous growths of the womb, being present in 25% of women age 35and above.   They can cause heavy or prolonged menstrual bleeding by increasing the surface area of the endometrium.


Adenomyosis. This condition occurs when glands from the endometrium become embedded in the uterine muscle, causing enlargement of the uterine cavity.


Endometriosis: This condition is due to the backflow of the menstrual blood into the pelvis.

Chronic pelvic infection: This  condition usually results from sexually transmitted diseases


Polyps: These are small, non-cancerous growths on the  endometrium, usually a result of high hormone levels.


Intrauterine device (IUD). Heavy menses is a side effect of the non-hormonal intrauterine contraceptive device.


Cancer. Uterine cancer, ovarian cancer and cervical cancer are occasional causes of excessive menstrual bleeding.


Other  medical conditions including thyroid problems, bleeding disorders, liver and kidney diseases may be associated with heavy menses


Iron supplements will not relieve heavy periods. You were given the supplements because the doctor suspected that you might have anaemia, a condition in which you don't have enough red blood cells to carry adequate oxygen in your body. With heavy periods and blood loss over a long time, your body’s iron stores would be depleted. The iron supplements rebuild your body's iron stores. You may also want to take vitamins containing folic acid, vitamin C, and vitamin B-12 to help build red blood cells. Please consult your doctor for further investigations and treatment.