Excessive menstrual bleeding
What are the causes of excessive menstrual bleeding?
Excessive menstrual bleeding could be due to the presence of
fibroids (benign growth of the muscle of the uterus), thickening of
the lining of the womb, or hormonal alterations in the body that
cause the excessive bleeding.
How can excessive menstrual bleeding be investigated?
Generally, women are offered an ultrasound scan of the pelvis to
assess the size of the womb, the presence of fibroids and thickness
of the lining of the womb. In women over 40, it is important to
obtain a sample from the lining of the womb for examination in the
laboratory to rule out any precancerous changes. Sometimes, women
need a small procedure done under anaesthetic called hysteroscopy,
where a small telescope is passed through the neck of the womb to
inspect the lining of the womb. This is done under a quick
anaesthetic.
If you would like to find out more
information about our womens' health services or to
book an appointment, you can contact us on
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2096897 or by filling out our online form.
What are the possible treatments of excessive menstrual
bleeding?
Excessive menstrual bleeding can be initially treated medically
with tablets to reduce the degree of menstrual bleeding. The
tablets will reduce the degree of bleeding and generally taken with
the period. The tablets, however, are not suitable for ladies with
irregular bleeding, in which case the oral contraceptive pill may
be helpful.
Other treatment options include the Mirena coil, which is
similar to the contraceptive coil, but releases the hormone
progesterone into the lining of the womb, which in turn can treat
heavy menstrual bleeding by thinning the lining of the womb. The
main advantage of this method is its simplicity and the fact that
it’s easily reversible if the patient decides to take the coil out.
The main disadvantage of this method is development of irregular
vaginal bleeding in the first six months of treatment, which tends
to settle down after that.
What are the definitive treatments of excessive menstrual
bleeding?
Surgical treatment tends to be more definitive and successful.
This includes endometrial ablation and hysterectomy.
What is endometrial ablation?
This is a quick surgical procedure where the lining of the womb
is burnt away by a special device inserted into the cavity of the
womb. This is done under general anaesthetic and normally takes
around 20-30 minutes. You will need to have a small telescope
examination of the lining of the womb (hysteroscopy) before and
after the procedure. There are different types of ablation devices
using either microwave, electricity (Novasure), or balloon filled
with heated water (Thermachoice).
Can anybody have endometrial ablation?
No, endometrial ablation is only suitable for women with normal
uterus, in the absence of fibroids or any other abnormality of the
womb.
How successful is endometrial ablation?
Around 60% of women will notice a significant improvement in the
degree of menstrual bleeding following endometrial ablation.
Endometrial ablation will not improve painful periods or the
cyclical pain associated with endometriosis or ovulation.
Hysterectomy
Hysterectomy involves removal of the womb surgically. This can
be a total hysterectomy, where the uterus and the cervix (neck of
the womb) is removed. Most of the time, this can be done through
key-hole surgery with minimal scars. Hysterectomy also can be
useful for ladies with pain in the pelvis and women with fibroids.
Sometimes, the hysterectomy can be done vaginally, with no
abdominal scars. Occasionally, hysterectomy has to be done through
an abdominal incision to remove the uterus. This is in cases of
large fibroids of the womb and women with previous surgeries. Our
consultants provide the unique expertise of performing key-hole
hysterectomy and vaginal hysterectomy in addition to the
traditional abdominal hysterectomy.
How long is recovery from hysterectomy?
This depends on the type of hysterectomy. Generally,
hysterectomy done through key-hole surgery or vaginally, have a
much quicker recovery time and return to normal activities
including driving. An abdominal hysterectomy (done through a cut)
is associated with a slightly longer hospital stay and slightly
more prolonged period of recuperation.