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The word “menorrhea” means excessive bleeding during a period. A period is considered heavy if one or more of the following are observed:

• Need to change a pad every 1 or 2 hours.
• Blood on clothes or sheets
• Need for ‘double’ protection such as a pad and a tampon
• Blood clots on the pad
• Interference with daily activities e.g. school, sports, etc.

What factors are responsible for heavy periods?

In order to have a ‘normal’ flow, ovulation must occur from the ovary. This requires the proper functioning of the axis that makes the ovary produce the necessary hormones. However, it is known that in the first two years after the onset of menstruation, this does not happen since the system that produces these hormones is still immature. Thus, periods are irregular and heavy. As we get older and the system matures, our periods also improve.

There are other, but less common, causes such as: clotting disorders or infections (if there is sexual activity).
Are heavy periods dangerous?

Heavy bleeding does not cause any medical problems other than a lifestyle disorder. Some teenagers lose a lot of blood and can develop iron deficiency anemia (low hematocrit). Anemia can cause problems such as dizziness, shortness of breath and fatigue.

Is monitoring necessary?

Keep a diary of your periods on a phone app or in writing for a few months and show it to your doctor. He or she will direct you if you need treatment. Note the amount of bleeding and the number of pads you need. Your doctor may offer you some treatment, and it is important to understand that most treatments take three or more menstrual cycles to fully work. A diary is helpful for both you and your doctor to see how bad your symptoms are and whether treatment is helping.

Are tests necessary?

Your doctor may ask you to have a complete blood count to see if you are anemic or have low iron stores, as well as a hormone test. Your doctor will take a detailed history to determine if your heavy bleeding started when your periods started, or if you have a family history or any unusual symptoms such as prolonged bleeding/frequent bruising. You may need an ultrasound of your genitals.

Is there a cure?

Of course there are solutions.

The options for managing heavy periods are:

• Non-hormonal pills – Mefenamic acid (ponstan) with or without Tranexamic acid (Transamin) during periods

Advantages: it is only taken for a few days during the period when the pain and bleeding are heavy and has very good results.
Disadvantage: Ponstan is a bit heavy on the stomach so it requires caution in women with sensitivity and always with your doctor’s guidance on dosage.

• Combined Contraceptives

Advantage: very effective treatment for heavy periods. It also helps with period pain, acne. But it also offers reliable contraception if you need it. The bleeding pattern is usually short and predictable.
Disadvantage: Side effects of contraceptives that can include breast tenderness, nausea, mood swings and headaches. Remember, however, that these are rare and in any case you simply stop the treatment.

The hormonal changes that occur at the beginning of puberty and even more so when the period starts are an emotionally charged time for every teenager. Our goal is to help as much as we can in the practical part and to support teenagers to understand that puberty is not a painful stage but a beautiful journey towards their adulthood.