Understanding menorrhagia: the significant effects of heavy periods on South African women

As August rolls around and we celebrate Women’s Month, it's essential to shed light on a pressing issue that affects millions of women in South Africa: heavy menstrual bleeding, known medically as menorrhagia.

This condition is often shrouded in silence, overshadowed by stigma and a lack of awareness, leaving many women to navigate their monthly ordeal in isolation.

What exactly is menorrhagia?

Menorrhagia is more than just heavy bleeding; it's a chronic condition where menstrual blood loss exceeds what is considered normal.

If you find yourself changing your pad or tampon every hour for several hours, experiencing periods that last longer than seven days, or passing blood clots the size of a quarter or larger multiple times a day, you might be dealing with menorrhagia.

For many women, this condition transforms menstruation from a routine monthly inconvenience into a debilitating experience that affects their quality of life.

A recent narrative review published in the "Annals of Medicine & Surgery" reveals that 10-30% of African women experience heavy menstrual bleeding. Despite ongoing public health initiatives aimed at reducing anaemia, more than 30% of women suffering from heavy menstrual bleeding also face iron deficiency, highlighting a serious and often invisible burden.

Heavy menstrual bleeding isn't just about the physical symptoms; it takes a toll on emotional well-being and social life. The fatigue, anxiety, and brain fog that accompany menorrhagia can interfere with daily activities, from attending work to enjoying social engagements.

The struggle is real, yet many women delay seeking help due to cultural stigma, low awareness, or financial constraints.

Vanessa Ascencao, a health and wellness expert, shares the importance of awareness.

"Women experiencing heavy periods, fatigue, or symptoms of anaemia should consult healthcare professionals," she advises. However, she warns that many frontline clinicians may not fully recognise the full spectrum of menorrhagia, which can lead to delayed diagnoses and treatment.

What’s behind the deluge?

• Hormonal imbalances: According to Mayo Clinic, when estrogen and progesterone fall out of sync thanks to PCOS, thyroid issues, or missed ovulation, your uterine lining may overbuild and shed excessively.
• According to the Lippincott Journal, uterine fibroids (especially common in African women), polyps, or adenomyosis can all lead to heavier bleeding.
• Bleeding disorders: Conditions such as Von Willebrand disease or clotting issues may make it hard to stop heavy bleeding. 
• Medications: Certain IUDs, blood thinners, and birth-control methods can worsen bleeding.
• Underlying conditions: Chronic illnesses (like liver, kidney, or thyroid disease), infections, and, in rare cases, uterine or cervical cancer may play a role

Risk factors that heighten the period

Lippincott Journals lists several circumstances that may increase your chances of experiencing menorrhagia:

• Being obese can fuel excess estrogen and hormone imbalance.
• Approaching perimenopause, when hormonal fluctuations run wild
• Living with chronic conditions like anaemia, diabetes, and HIV weaken your body’s resilience to heavy blood loss.
• Facing nutritional deficiencies, especially iron and folate, which worsen bleeding symptoms.
• Enduring cultural stigma, limited healthcare access, and a lack of awareness, especially in African communities, keep women from seeking help.

Heavy periods don’t just make things messy; they can lead to serious complications:

Iron deficiency anaemia: According to "Verywell Health", losing blood drains your iron reserves, which makes your body not produce oxygen-carrying red blood cells. That’s when fatigue, dizziness, paleness, and a racing heart drain your energy.

Quality of life decline: Students, professionals, mothers, one escapes fatigue, brain fog, missed work or school days, and the emotional drain of “hiding” heavy periods.

Compromised fertility: While heavy periods alone don’t cause infertility, they can signal underlying issues like fibroids or hormonal imbalances that may affect conception. Checking in with your doctor is a smart move.

Solutions and support

In addition to medical intervention, lifestyle changes can also play a significant role in managing heavy periods. Ascencao recommends maintaining a balanced diet rich in iron, managing stress effectively, and considering the use of natural, clinically proven iron supplements to combat fatigue and support overall health.

Track your periods: note how long they last, how often you change pads or tampons, clot size, and how it impacts your day.

See a health provider: head in for a check-up. Ask for iron (ferritin), thyroid, and bleeding disorder tests if needed.

Prioritise nutrition: boost iron-rich foods (like leafy greens, fortified cereals, lean meats), manage stress, and keep active to support healthy flow and energy.

This Women's Month, let's break the silence surrounding heavy periods. By educating ourselves and others about menorrhagia, we can combat the stigma and empower women to seek the help they deserve.