Published on 24 July 2022

    Heavy flows are not unusual, especially in the first few days of your menstruation. However, when accompanied by debilitating cramps, large clots, or longer-than-usual periods, they could signal a more serious gynaecological condition. Two of the most common causes are endometriosis and fibroids.


    Endometriosis is a condition in which cells similar to the womb lining (called the endometrium) grow outside of it. They can grow on the ovaries, on the outside of the womb, or in the pelvis, bladder, urinary tract, bowel tissues, and other organs. These displaced tissues act just like the endometrium and with each menstrual cycle, thicken, break down and bleed.

    The condition affects 10% of women who are of reproductive age. Common symptoms include:

    • Severe period pain, which is present in 40% to 60% of women who have painful periods

    • Excessive menstrual bleeding

    • Chronic pain in the pelvis

    • Pain inside the vagina during or after sexual intercourse

    • Pain during bowel movement

    • Chest pain, shoulder pain, and/or back pain during periods

    Endometriosis is a leading cause of infertility, as the displaced tissues can obstruct the fallopian tube and prevent sperm from reaching the egg. About 30% of women with endometriosis have difficulty getting pregnant. 


    Fibroids too can cause atypical periods. These are non-cancerous ‘rubbery’ growths that vary in shape and size grow and can grow in the cavity or inner and outer wall of the uterus. They are very common, affecting about seven in ten women, and do not usually cause any symptoms. 

    However, about 25% of women with fibroids experience some signs. These include:

    • Heavy bleeding or painful periods

    • Bleeding in between periods

    • Feeling pressure or fullness in the lower abdomen

    • Frequent urination

    • Lower back pain 

    Large fibroids can also lead to infertility and can increase the risk of miscarriages.

     Treatment Options
     Endometriosis Uterine Fibroids
    Endometriosis can be treated with medications and/or endometriosis surgery, depending on factors such as symptom severity, extent of affected organs, a woman’s age, and whether she wishes to get pregnant. It also depends on the potential  side effects and complications of drugs or procedures.Most uterine fibroids do not require treatment, especially if they do not cause symptoms or are not overly large. Regular check-ups are useful to monitor their growth. Fibroids are hormone-dependent and usually decrease in size after menopause. Treatment can be considered if a fibroid is causing pain or preventing conception.  
    Hormonal suppressants (e.g. progestin, combined hormonal pills) or birth control pills: These hormone medications may reduce heavy periods. Hormonal suppressants can also help suppress endometriosis-related pain.
    Pain medication: Painkillers can help manage cramps.
    A progesterone impregnated intrauterine device (IUD): This device fits inside the womb and releases a steady flow of hormones to counteract heavy periods. It also acts as birth control.Iron supplements: If iron deficiency is among the symptoms, iron tablets may be prescribed. 
    Laparoscopic surgery: Surgical removal of the displaced endometrial tissues, which can improve the chance of natural conception.

    Laparoscopic myomectomy: Surgical removal of fibroids can improve the odds of conception.

    Uterine fibroid embolisation: A procedure that cuts off the blood supply of the fibroids under X-ray guidance. 
    Hysterectomy: Women who have severe symptoms and who have passed their childbearing years may consider removing the uterus and all the fibroids. This can be done using keyhole surgery.

    At the National University Hospital (NUH) Women’s Centre, period pain and severe symptoms are taken seriously because these issues can negatively affect women at the peak of their lives, affecting fertility and lowering their productivity and quality of life. If you suffer from any of the symptoms, consider visiting a doctor to check for underlying issues and weigh the pros and cons of treatment.

    In consultation with Dr Ma Li, Consultant, Division of Benign Gynaecology, Department of Obstetrics and Gynaecology, NUH.

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