Wednesday 16 January 2019

Ask the GP: My periods are very heavy and I'm worried

Photo posed
Photo posed

Nina Byrnes

Q: I'm 33-years-old and have had really heavy periods since having my last baby. For the first few days my activities would be severely curtailed. I also had a miscarriage and the periods feel very reminiscent of that - psychologically this is quite difficult to deal with. I'm very tired and worried that I'm becoming anaemic. Should I seek to discuss this with my doctor? Or just get on with it as something that happens in the normal course of childbearing? I might add that I really do not want to go on the pill to regulate my cycle. What other options are there?

A If menstruation is heavy or prolonged there is a risk of iron deficiency and anaemia. This can have knock on effects for your health and wellbeing, so it should be addressed. Periods often change after childbirth, but it doesn't mean you have to tolerate this as the status quo.

Clotting problems are a rare cause of heavy menstrual periods. This is more likely if other bleeding issues are apparent such as frequent nosebleeds, bleeding gums or easy bruising. Clotting disorders can also run in families. Other causes could be, under active thyroid or polycystic ovarian syndrome. However, these can all be out ruled via simple blood tests performed by your GP.

A pelvic examination and ultrasound can help rule out abnormalities of the womb or ovaries. Ensure your smears are up-to-date. A reduced blood count warrants treatment with iron supplements.

For those who want to avoid hormonal contraception, medication such as mefenamic acid (an anti-inflammatory), combined with tranexamic acid may help. This should be taken regularly three times daily for the expected heavy days. This combination helps reduce menstrual flow and can improve symptoms.

If this doesn't work the contraceptive pill can be used. I know this isn't your preferred choice, but this can quite dramatically reduce menstrual flow and will help regulate menstrual bleeding. Those over the age of 35, smokers, women who have high blood pressure or high cardiovascular risk may not be prescribed the combined contraceptive pill, patch or vaginal ring.

If oestrogen isn't an option then maybe consider a method, which uses progesterone only. Options here include a progesterone only pill, depot progesterone injection, contraceptive implant or intrauterine system. The progesterone only pill must be taken daily. The depot injection is given every 12 weeks. The contraceptive implant is about the size of a hairpin and is placed under the skin of the arm. It can stay in place for up to three years.

There are three hormone-coated coils available. These coils release a small amount of progesterone continuously for three or five years. Progesterone only methods are very effective at reducing menstrual flow, so are particularly helpful in those who have heavy or painful periods. In 10 to 20pc of women periods may stop altogether, but they will return once contraception is stopped. Irregular menstrual bleeding may be a disadvantage for some women as it may be difficult to predict and can be prolonged. This is most common in the first six months of treatment and usually settles down.

More rarely a change in menstrual bleeding can reflect issues with the cervix or womb, so assessment and examination is important to rule these out.

Visit your GP who can examine and assess you, recommend next steps and advise you on the benefits risks and side effects of all methods to help you decide which one is best for you.

Q. The sunny weather's here - and once more I have a cold sore!  I always get cold sores when the sun comes out, even though I wear lip balm. Any advice? 

A. The Herpes Simplex Virus causes cold sores. The virus is passed on by close contact with someone who is actively infected. You can pass on the virus even if blisters are not present. Other modes of transfer include, sharing lip balm or lipstick, sharing food utensils or bottles and sharing razors or towels.

The main cause of a cold sore flare is usually a dip in the immune system. This can occur during other colds or viral infections. Other triggers include exposure to UV light (sun exposure), stress, fatigue, menstruation, or just being generally run down.

Over the counter antiviral creams such as Acyclovir (Zovirax), can be helpful if used early, as in, when the first tingling occurs. If symptoms are severe or if sores are near the eye prescription antiviral tablets can also help.

The best way to prevent flares is to identify and avoid your personal triggers. Make sure you eat well and get plenty of rest. Do your best to keep stress to a minimum and avoid strong sun exposure. Wear sunscreen when out and about. Be vigilant for early signs of a flare, specially if you have a cold or illness and keep antiviral cream to hand to use if necessary. If flares occur very frequently, antiviral tablets are sometimes prescribed at a lower dose for a longer period to keep the virus at bay. Alternative remedies are not proven helpful, but some do say taking the amino acid lysine helps reduce attacks. Many foods contain lysine including chicken, turkey, fish and beans

Ultimately if a cold sore does appear, try not to become too stressed. Cold sores are not dangerous and although they may make you self-conscious remember they are very common and they will go away.

If you have any health queries for Dr Nina Byrnes, please email Please note that Dr Nina cannot enter into individual correspondence

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