Heavy Periods (Menorrhagia)

What causes heavy periods?

There are several causes of heavy periods. During teenage years and coming up to the menopause are the commonest times in a woman?s life to have heavy painful periods. Causes include:

• Dysfunctional Uterine Bleeding
  This is the term used to describe heavy painful periods when no gynaecological cause is found. It is thought to be perhaps to a hormonal imbalance and usually occurs as women get older from 40 to 50 years.


• Fibroids
  This is a growth in the muscle of the womb (myometrium). Fibroids are usually benign and rarely cause cancer of the womb. They can be inside the cavity of the womb (submucosal), in the wall of the womb (intramural) or protruding from the surface of the womb (subserosal). Some women have one, or lots of little fibroids and other women may have very large fibroids, causing swelling of your abdomen (tummy), perhaps requiring you to go up a few dress sizes.


• Endometrial Polyp
  This is a small growth, usually about the size of a pea, from the inside lining of the womb (endometrium). It is more common in women who are coming up to the menopause and who may be on hormone replacement therapy (HRT). An endometrial polyp can also occur in women who are taking treatment for breast cancer. The majority of endometrial polyps are benign, but some may turn to cancer. These can be easily treated to prevent that.


• Endometrial Hyperplasia
  This is when the inside lining of the womb becomes thickened and is at risk if not treated of turning into cancer. It is also more common in older women coming up to the menopause or women who are overweight or have had no children (nulliparous). This can also be easily treated to prevent turning to cancer.


• Endometrial Cancer
  This is cancer of the inside lining of the womb. It is a rare cause of heavy periods as it is more common in older women after the age of the menopause. It also occurs more often in women who are overweight or those who have had no pregnancies (nulliparous). Cancer of the womb starts in the inside lining (endometrium) and as the womb is made up of many layers, the cancer is usually diagnosed early, and there is a very good prognosis for many women.

What should I do If I suffer from Heavy Periods?

It is important to investigate heavy periods not just because of the effect they have on your quality of life and to rule out any of the above conditions but also to make sure that you do not have a low blood count (anaemia) as this can cause exhaustion and put pressure on other organs, especially your heart.

You should therefore seek help from your GP or attend Marble Arch Private Health Care, where you will see a Consultant Gynaecologist.

Some Important facts you should tell the doctor:

• How long have you suffered heavy periods? Since teenage years or just recently?
• How many sanitary towels or tampons you use per day
• Do you leak through sanitary towels staining clothes, bed clothes, etc
• Are there many clots
• Do you suffer from flooding where blood runs down your legs to the floor
• Does pain accompany your heavy periods

Medical Examination

When you attend a Gynaecologist you will require an examination of your abdomen (tummy) and pelvis (vaginal examination) This will assess if the womb (uterus) is enlarged.

You will also have an ultrasound scan. This may be performed through your tummy (transabdominal) or through the vagina (transvaginal). A transvaginal scan uses a narrow probe placed in your vagina. It may cause a little discomfort but should not cause pain.

You will have a blood test checked to make sure your blood count is not low.

Depending on the findings of the vaginal examination and ultrasound scan you may need to have a Hysteroscopy.

What is a Hysteroscopy?

This is where a camera is placed inside the womb through the vagina. This can be done under local or general anaesthetic and will be performed in hospital. You should not have to stay in overnight. This looks at the inside of your womb and the Gynaecologist can recognize any of the above conditions. A biopsy (small sample of tissue) will also be taken during this procedure to send to the laboratory to confirm the diagnosis. If an endometrial polyp or fibroid is seen this may be removed at hysteroscopy.

Treatment of Heavy Periods

There are many different treatment depending on the above conditions. Some treatments are not suitable if you want to have more children.

Your Doctor will if possible try the least invasive treatment, with the least side effects. You will be provided with an information leaflet on whichever option that is chosen for you.

Tablets

If you have Dysfunctional Uterine Bleeding you can take tablets during your periods which will reduce the amount of bleeding. For some women this is adequate.

Injections

Other stronger medication can be given in the form of an injection (gonadotrophin releasing hormone (gnrh) analogue,) once per month for 6 months. The injection (gnrh analogue) effectively puts your body into the menopause and prevents you from producing an egg and thins the inside lining of the womb to reduce heavy periods, it also shrink fibroids. Women taking this injection do get symptoms of the menopause; such as hot flushes and night sweats. A form of hormone replacement therapy (HRT) can be given in tablet form daily to overcome these symptoms, with no increased risk of breast cancer. This treatment option works well for many women.

Intrauterine System

This is a type of ?coil?, also used for contraception. It is now licensed for the treatment of heavy periods. It slowly releases a hormone called progesterone, which thins down the inside lining of the womb. This is suitable for the treatment of dysfunctional uterine bleeding, endometrial hyperplasia and over perhaps 12-18 months can shrink fibroids. This system also has the benefit of providing a very reliable method of contraception and can be used in women who have not finished having babies.

Endometrial Ablation

This procedure burns the inside lining of the womb (endometrium). It is done in a hospital as a day case under general anaesthetic. This can have good results for many women, some not having any periods at all. Occasionally this procedure may have to be repeated after a number of years if the inside lining of the womb (endometrium) grows back.

Myomectomy

This is for the removal of fibroids. This is an operation under general anaesthetic where the abdomen (tummy) is opened and the fibroid or fibroids are removed from the womb. This can be successful for some women especially if they want to try for another pregnancy. There is however a high risk of bleeding which may only be cured by a hysterectomy (removing the whole womb). It should be considered though in women who want to retain their fertility.

Hysterectomy

This is usually left as a last resort in the management of heavy periods, either when some of the above treatments have been tried or when there is cancer or large fibroids. A hysterectomy can be performed either through the tummy (abdominal), key hole surgery (laparoscopically assisted) or vaginally (from below, suction method to some). Your Gynaecologist will give you more information on this. Your ovaries may also be removed if required during a hysterectomy.