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 women's health services or to book an appointment, you can contact us on 01462 410 002 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 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.