Heavy periods or menorrhagia
Definition
Heavy menstrual bleeding is defined as bleeding lasting more than 7 days or actual blood loss greater than 80mls. However, bleeding is regarded as excessive if the loss interferes with a woman’s social, family or work life.
Every year around 5% of the female population aged between 30 and 50 years consult their general practitioners with heavy menstrual bleeding or menorrhagia.
Investigations
You will be initially seen by the Consultant who will take a full history and perform an internal examination. You may then be referred for an ultrasound scan or possibly a hysteroscopy (a keyhole examination of the inside of the uterus). Please see the information section for further details on ultrasound scans and hysteroscopy. A blood test will be taken to assess whether you are anaemic or not.
Treatment options
Some women will be reassured if the investigations are normal and opt to have no treatment. For those wanting further help with their periods, the treatment options are detailed below. Women will be able to choose the therapy that is right for them after a full discussion with their Consultant.
Hormonal treatments
- The Mirena™ system is inserted into the uterus like an intra-uterine device. It releases a hormone called levonorgestrel which reduces menstrual loss in up to 90% of women. It has the advantage that it is also an excellent contraceptive. Side-effects can be troublesome and consist of irregular bleeding lasting up to 6 months, breast tenderness, headaches, acne and mood changes.
- The combined oral contraceptive pill (COCP). Again, this is a contraceptive, but also has possible side-effects of headaches, mood changes and weight gain. More rarely women can suffer a deep vein thrombosis on this treatment; for this reason women over the age of 35 years of age who smoke should not be prescribed the COCP.
- Injectable or oral progestogens. These medications can cause irregular bleeding and other side-effects of weight gain, headaches and breast tenderness. They do not increase the risk of thrombosis however.
- Gonadotrophin releasing hormone analogues are given by monthly injection or as a nasal spray. They make a woman menopausal for the length of the treatment and therefore can have the side-effects of hot sweats and flushes, vaginal dryness and joint aches. These symptoms can be offset by giving a small amount of hormone replacement therapy (HRT) at the same time.
Non-hormonal treatments
- Tranexamic acid reduces the amount of blood lost by 50%. Possible side-effects are rare, but consist of nausea and headaches. This medication is generally given for 3 months and stopped at this point if no improvement has been seen. It can be used in conjunction with one of the hormonal methods outlined above.
- Mefenamic acid is a non-steroidal anti-inflammatory drug which is especially useful if a woman has pain associated with her periods.
Surgical options
- Endometrial ablation
There are a variety of techniques available; the correct one for any one woman depends on the size and shape of the womb and whether any fibroids are present. All the procedures aim to destroy the lining of the uterus. Around 50% of women will never have a period ever again after an ablation procedure, with overall 85% being satisfied the result. The remainder may require further treatment. An ablation can be performed in the outpatient clinic, but more commonly requires a short general anaesthetic. Whilst the procedure is not a contraceptive, it is inadvisable to become pregnant after an ablation, so the operation is only suitable for women who have finished their family.
For more information on endometrial ablation, please see the information section.
- Hysterectomy
This is an operation to surgically remove the womb. Often the cervix, the neck of the womb is removed at the same time. The procedure can be done by the abdominal or vaginal route using a general or spinal anaesthetic. This operation is the only one that guarantees that a woman never has a period ever again, but carries the risks of an anaesthetic and of major surgery. Recovery is slower than after an ablation procedure, but satisfaction rates after hysterectomy are high. For more information, please see the information section.