Heavy Periods

 

Heavy periods (Menorrhagia) are a very common problem. Approximately 1 in 20 women, between the ages of 35 - 50, will experience heavy periods. Heaviness of periods is very one sided, what is abnormal for some may be considered normal by others. The duration of a period and amount of loss varies considerably from woman to woman. Measurement of the exact amount of loss is very difficult.

 

Periods are heavy when you are losing excessive amounts of blood and you find it necessary to change tampons or pads frequently or you are losing large clots (like pieces of liver) . If you are experiencing very heavy periods over a long period of time then anaemia (thinning of the blood) may result. Anaemia can cause excessive tiredness, faintness and shortness of breath.

 

The exact cause for heavy periods is not clear. In most cases it may be due to hormonal imbalance, which in some cases may be short-lived and self-correcting. In some women, usually over the age of 40, the heavy bleeding is due to fibroids.

 

Fibroids are benign (non cancerous) lumps of muscle and fibrous (tough, stringy) tissue that grow in the muscle of the uterus (womb). If they grow inwards towards the cavity of the uterus they can cause heavy and/or prolonged bleeding. Other rare causes of heavy periods include thyroid deficiency, infection, haemophilia (inherited bleeding disorder) or retained tissue after a miscarriage.

 

Keep a menstrual diary for a few months. If the flow is so heavy that you start feeling dizzy or faint then make an urgent appointment to see your doctor. In the meantime start taking iron tablets and eat iron-containing foods such as liver, red meat, green vegetables and dried fruits like raisins and prunes. Your doctor will arrange a blood test to check your iron levels and stores (haemoglobin and serum ferritin).

 

The doctor will carry out a pelvic examination and will arrange a pelvic scan to see whether you have fibroids and to check the thickness of the lining of the womb. If the lining is too thick, especially in women over the age of 45, hysteroscopy and curettage may be advised. Hysteroscopy is a thin telescope that is passed through the neck of the womb (cervix) to visualise the cavity of the uterus. A sample of the lining can be obtained for tissue analysis and fibroid/s excluded. The procedure is commonly performed as an outpatient procedure.

 

Fortunately, nowadays there are a range of treatment options to choose from. These include:

  1. Medical treatment. The drug tranexamic acid increases the blood clotting system and helps to decrease the flow by 50%.

     

  2. Intra-uterine progesterone-releasing system MIRENA. This is a contraceptive device which releases levonrogesterol (Progesterone) and thins down the lining and can decrease the flow by 85-90%.

     

  3. Endometrial ablation. There are several techniques available that aim at destroying the lining of the womb. They are suitable for women who have completed their desired family unit or do not wish to have a family. These procedures can be performed as outpatient or day case procedures. The recovery takes a few days. Examples of endometrial ablation techniques include: laser ablation, endometrial resection, thermal balloon ablation, Novasure ablation, radiofrequency, cold coagulation of the lining and hydrothermal ablation. The choice of these techniques depends on their availability in your local hospital and the experience of your gynaecologist with the particular technique.

     

  4. Hysterectomy (removal of the uterus). Hysterectomy is the definitive cure of heavy periods. This operation can be performed through the vagina (vaginal hysterectomy), or through a bikini line cut (abdominal hysterectomy), or by key-hole surgery through small incisions (cuts). The choice of operation depends on the size of the uterus and the surgical skills of the gynaecologist. Hysterectomy can be subtotal (the cervix is left behind), or total (removal of the uterus with the cervix). The recovery is quicker after vaginal and key-hole hysterectomy.

Hysterectomy is usually considered as a final option when other treatments have failed, as there are more risks with the hysterectomy operation when compared to the other options.

 

It is important that the pros and cons of each treatment option are discussed thoroughly with you and the ultimate decision is yours.

 

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Last page update : 00.00 - 17th Oct 05