We are delighted that Dr.Brooke Vandermolen, or The OBGYN Mum, has collaborated with us on this important topic. Brooke is an NHS doctor currently working and training in Obstetrics and Gynaecology (or OBGYN as it is known in America!). Much more exciting than this, however, is that she recently became a mother herself. Experiencing pregnancy and labour as a patient was one of the most transformative experiences of her career. This new perspective drove her to seek out and share answers to the questions she had herself when pregnant.

Recently Brooke polled her Instagram followers to see what gynaecological issues concerned them the most, and heavy periods was one of the most requested topics! For far too long women put up with this issue in silence, planning out their days according to where they will be able to change their sanitary protection. However, there is so much information and help that is available. Here's the top 7 things to know!

1. Theres no ‘right’ amount of blood to lose

Most women will lose around 80ml of blood during their period. Your period is described as heavy if you lose more than this amount, or your periods last for 7 days or longer.

However, what seems heavy for one woman may feel completely normal for another. Therefore to help you work out if your bleeding is generally considered excessive see if it fits with any of these issues:

• Having to change your sanitary products every 1-2 hours
• Passing blood clots larger than 2.5cm (about the size of a 10p coin)
• Bleeding (flooding) through to your clothes or bedding
• Needing to double up on sanitary products (eg tampons and pads)

This link has a great quiz you can take to see if your periods are too heavy: https://www.nhs.uk/conditions/heavy-periods/

2. Sometimes theres an underlying cause for your heavy bleeding

For about half of women, there is no underlying cause. However, if you think your period is excessively heavy for your then seeing your own doctor can help decide if further testing would be useful to identify any underlying issue.

Some conditions of the womb and ovaries can cause heavy bleeding, including:

• Fibroids – these non-cancerous growths or masses that develop in or around the womb and can cause heavy periods.
• Endometrial polyps – similar non-cancerous growths in the lining of the womb or cervix (neck of the womb)
• Endometriosis – The tissue that lines the womb (endometrium) may be found outside the womb, such as in the ovaries and fallopian tubes (although this is more likely to cause painful periods)
• Adenomyosis – Tissue from the womb lining can become embedded in the wall of the womb; this can also cause painful periods.
• Pelvic inflammatory disease (PID) – an infection in the upper genital tract (the womb, fallopian tubes or ovaries) that can cause symptoms like pelvic or abdominal pain, bleeding after sex or between periods, vaginal discharge and a high temperature
• Womb (endometrial) cancer – this is very rare in pre-menopausal women, and would tend to be accompanied by a sudden or new change in the pattern of bleeding, rather than lifelong heavy periods.

Other conditions that can cause heavy periods include:

• Blood clotting disorders, such as Von Willebrand disease
• Underactive thyroid gland (hypothyroidism) – if the thyroid gland does not produce enough thyroid hormone it may cause tiredness, weight gain and heavy periods.
• Diabetes

3. Having tests may help find the cause

Your GP may begin by doing basic blood tests, which will include checking to see if you are anaemic and your thyroid hormone levels.

After a physical examination they may suggest further tests such as:

• An ultrasound scan
• Hysteroscopy – where a narrow telescope with a light and camera at the end is passed into the womb through the vagina to examine the inside of the womb
• Endometrial biopsy – this is usually done during hysteroscopy, and involves taking a sample from the lining of the womb.

4. Losing too much blood may make you anaemic

When you have heavy periods, this can cause you to loose blood at a quicker rate than you can replace. This can make you anaemic, meaning there are not enough red blood cells to carry oxygen around the body. This can make you feel very tired, dizzy or short of breath.

If you think you may be anaemic, your GP can check with a blood test and prescribe iron replacement with tablets.

5. There are lots of treatments that help

Fortunately, we live in a time when you dont just have to put up with these issues forever! There are lots of treatment options out there, some of which are easy to get hold of and others more invasive. Some options include:

• A coil aka intrauterine system (IUS) – a small device, often known as a mirena, that contains the hormone progestogen is inserted in your womb.
• Non-hormonal treatments – such as tranexamic acid or non-steroidal anti-inflammatory drugs (NSAIDS)
• Hormonal treatmnets – such as the combined oral contraceptive pill or progestogen tablets
• Endometrial ablation – a procedure to remove the lining of the womb
• Myomectomy – surgery to remove fibroids
• Uterine artery embolisation – a procedure to shrink fibroids
• Hysterectomy – surgery to remove to the womb

6. Which treatments you have depends on when you want to have children

Its really important to discuss your plans for a family with your doctor before starting any treatments. If you don't wish to have children immediately, then the hormonal treatments, such as the mirena or combined pill, will usually give you great control over your symptoms.

If you know you have completed your family, then you may prefer to opt for more definitive surgical treatments.

7. Your plastic-containing period products will take an average of 1000 years to biodegrade

According to the Women’s Environmental Network, in the UK, every woman and person who menstruates, uses over 11,000 disposable menstrual products in their reproductive lifetime.

Tampons, pads and panty liners generate over 200,000 tonnes of plastic-containing waste per year. Pads are around 90% plastic and ends up in landfill, seas and rivers. This plastic can take many thousands of years to decompose.

Many tampons and pads are made from cotton that was sprayed with chemical pesticides, which destroy biodiversity and cause potentially lethal pesticide poisoning in cotton workers. Thats why newer products, such as the Yoni or & Sisters tampons are organic, and contain no plastic or perfume.

Environmentally friendly sanitary pads also exist, such as Flo, which are made from 100% bamboo; a plant that is fast growing, greenhouse gas-absorbing, biodegrading, high oxygen releasing, microbe-busting, soil-restoring and waste-reducing. They also donate a percentage of their profits to ending period poverty.

The best way of reducing the impact of period products on the environment is to use eco-friendly options such as menstrual cups from &Sisters, period underwear and reusable sanitary pads.