Dr Laura Knox

Brief Outline:

Dr Laura Knox is a haematology doctor working in Scotland. She is interested in supporting young people with period difficulties, where bleeding and bleeding health conditions may be relevant.

Dr Laura Knox, a haematology doctor, explains that if period bleeding impacts on how people feel or what they can do, there are things that can be done to help and encourages young people to see a doctor for any concerns.

Hi. I'm doctor Laura Knox, and I'm a Hematology Doctor that works in Glasgow. Hematology doctors, means that we deal with bleeding disorders or people that have problems with their blood. And I sort of specialize in heavy periods and bleeding disorders.

And I wonder, would you have any, message or explanation for young people who might be trying to work out whether their period are heavy or how they might explain that, or what sort of measures you might use, or what you might ask if you saw them in clinic.

So how do we view heavy periods? It's changed quite a lot in the last few years. NICE, which is one of our organizations has a lot of guidelines and guidance has changed the definition to really reflect on heavy periods being anything that impacts on a girl or woman's life, either in their academic ways, work, school or social activities, rather than a specific measure which it used to be done in the lab.

So in general, I think if you're asking the question, “Are my periods heavy it's very reasonable to be assessed. Things that I sort of look out for in clinic are if you're changing pads frequently, especially if it's within 1 to 2 hours, flooding, changing your pads overnight, clots that are passing.

Those are all features that suggest to me that it's worthwhile getting checked out, but if there's anything you're concerned about, that's usually the time to go and get seen.

So would young people be expected to know how much blood their passing or like an amount of blood. Or you think it's more those practical measures that you use?

I think definitely practical measures. I think it's really difficult to actually estimate blood loss. At the small amount of blood and water can look very, very dramatic or sometimes not very much. So really the things that I look for when I’m assessing these people are whether they have had issues that are impacting them or if it's causing them concern, anything that's causing you worry, it shouldn't be periods are part of life, but they shouldn't be a difficult part of life. There's definitely things we can do to make them better.

Dr Laura Knox gives some of the possible reasons for why periods are heavy. If it’s health conditions that affect how easily blood clots these can be looked for with specific blood tests, so seeing a doctor about heavy periods can be helpful.

What sorts of things or what sort of health conditions might you think about if you saw somebody with health with, with really having periods from a, from a bleeding point of view?

So yeah. So, when you attend for heavy periods, you can usually see your GP first, but sometimes that can lead on to assessment by other types of doctors. There's lots of different causes for heavy periods. And also, multiple causes can coexist at the same time. From my side of things am I know as a bleeding disorder specialist that when periods are heavy from when they start, it can sometimes be that those patients or those girls are more likely to have an underlying bleeding disorder, which essentially is a problem with the blood in the way it clots.

And the things I look out for patients when they're presenting, or girls that are coming to me with problems of their periods that may be necessary to see me, would be if there's a family history. So if your parents, your siblings have bleeding problems, and particularly something's asking your mum or sisters, because sometimes periods can be really normalized and if all your experience has been of people around you having heavy periods, you don’t necessarily notice them as being heavy. If you've had other bleeding symptoms like nosebleeds or gum bleeding. Again, that's another thing that maybe flags up that there might be something else going on. If that is the case, then there are tests that can be done and that can one help us treat your periods but also prevent bleeding, complication or bleeding problems further down the line.

There are lots of different bleeding disorders that some are quite rare. The most common is one called Von Willebrand Disease (VWD). The reason I mention it is because people think of bleeding disorders, they often think of haemophilia and think of the fact that haemophilia affects boys, Von Willebrand Disease (VWD) is the most common bleeding disorder, and it has a pretty even spread between men and women. So, it's just something to think about. And as I've said, if you're worried, it's no problem to be seen.

What sort of tests might you do to look into a bleeding problem from a haematology point of view?

So, from a haematology point of view, we usually take some blood tests. So, some of them are just to look at the amount of blood cells in the blood. And then there are more specialist tests that can look at test how well the blood clots that tend to be when I get involved. What I would say is that we would usually do some of the tests alongside, like ultrasounds that you can have from other conditions, because we're always remembering in the back of our mind that two things can happen at the same time. So, it's just to make sure we're not down a rail road of one school of thought.

Dr Laura Knox explains that sometimes heavy period bleeding can contribute to or cause a lack of iron or anaemia. It is easily tested for and treated, so she encourages young people to see a doctor if they have any concerns about this.

So, there's the features of heavy bleeding that you've talked about whereby you might realize you're passing kind of heavy amounts of blood. What sort of impacts could that have on a young person?

So yeah. So, when you have heavy blood loss, especially regular heavy blood loss, which can happen if your periods are heavy and you can become both iron deficient and sometimes a consequence become anaemic. And anaemic is essentially a word meaning a low blood count. Iron is really important in how you make your blood cells, and your blood cells, your red blood cells are important to take oxygen around your body into all your organs. So, if you're deficient in iron or your iron is low, it can impact the sort of how that works. And that can make you feel quite fatigued, tired, sometimes breathless. And if anaemia develops. So that's when a low blood count happens as well as for as a consequence of the low iron that can compound it further.

So, more tiredness, more breathlessness sometimes being pale, sometimes noticing pale skin. And it's always a bit of a bit of a cycle. And it's really important because we miss a lot of iron deficiency. But we know that heavy periods themselves and the complications of heavy periods can have a real impact on a young person can affect their ability in school. We know that it's caused, differences in exam results for girls. And the most important thing and the reason it's important is because its easily treatable and easily tested for. To test for low iron is a blood count. So, blood count to look at your haemoglobin or your full blood count level that’s your red cell amount or the amount of haemoglobin in those cells which the oxygen carrying capacity, and a ferritin, which is a measure of an iron source.

That's the amount of iron that's in your body. And both of those markers can give us an indication of iron is poor. The treatment of that is with some oral tablets. Usually there's some misinformation about iron. We've changed how we prescribe it. We give it much less than we used to. And actually, that works much better and doesn't cause the negative side effects that some people worry about iron and there's other forms that we can do if that is an issue. So, I'm very passionate about it because it's something easily treatable that can make you feel a lot better. Rather than this negative cycle of heavy bleeding, low iron all compounding and then if anaemia comes on top of that as well.

So, an easy test to do and an easy solution if that's a problem.