Heavy Periods - MENORRHAGIA

Heavy periods are a common concern among women before menopause. The medical term for heavy menstrual bleeding is “menorrhagia”.

If you have menstrual bleeding so heavy that you dread your period, especially when your period have causes enough blood loss and cramping that you have to restrict your daily activities, talk to your GP or gynaecologist. There are many effective treatments for menorrhagia.

Causes of heavy periods

The common causes of heavy menstrual bleeding are:

• Not ovulating regularly once per month – This causes your menstrual period to be irregular or absent, and once the period returns it causes heavy bleeding.
• Having abnormal growth in the uterus – The most common non-cancerous (benign) growths are:
  • Polyps - small, grape-like growths of the lining of the uterus. They can be removed by a minor endoscopic surgery called hysteroscopic polypectomy.

  Know more about endometrial polyp and its treatment

  • Fibroids – very common non-cancerous (benign) growths from the muscular wall of the uterus.

  Know more about fibroid and its treatment

• Having a condition that increases bleeding throughout the body – This happens when women are taking certain medicines like blood thinner, or when they have some known medical conditions that cause them to bleed easily.

In particular, seek medical help if you experience:

• Anaemia as a result of heavy periods. This would mean that your bleeding is rather heavy. You doctor may suggest iron supplement to correct anaemia and improve your overall wellbeing.
• Bleeding between periods or frequent vaginal bleeding.

What can your doctor do for you?

Depending on your symptoms and medical background, your GP may:

• perform a pelvic exam;
• arrange blood tests to look for anaemia, a bleeding disorder or thyroids disease;
• recommend iron supplements if you have anaemia or low iron levels on blood tests;
• perform Pap smear for you if it is overdue;
• arrange a pelvic ultrasound scan - Ultrasound scan uses sound waves to produce an image of the uterus and ovaries. It can help to detect growths such as polyps and fibroids; or
• recommend some simple first-line drug therapy.

How can your Gynaecologist help you?

You may need to see a Gynaecologist when:

• your symptom is severe;
• your bleeding has not improved with the first-line drug therapy;
• pelvic ultrasound scan suggests the possibility of abnormal growths, such as polyp or large fibroids;
• your bleeding is so heavy that it has caused anaemia;
• you have irregular bleeding pattern that warrants further tests by a specialist; or
• you may benefit from more advanced therapies or surgical treatment.

We will help you to work up the cause of heavy periods and to determine the best treatment strategy for you. Specific treatment will be tailored to the condition and needs of individual woman. It is based on a number of factors, including:

• the cause and severity of the condition
• your menstrual cycle pattern and presence of menstrual cramp
• your tolerance for specific medications and procedures
• your future childbearing plans
• your age, overall health and medical history
• your lifestyle and personal preference
• any risk factors that signify the need of ruling out cancer

Our specialized treatment programmes

The followings are some examples of our treatment packages for menorrhagia. They may be used alone, in combination, or as part of a stepwise management strategy.

• One-stop pelvic ultrasound scan and counseling

A pelvic ultrasound scan is one of the essential tests in many cases of menorrhagia. It is particularly useful to look for any abnormal growths in the uterus and ovaries, such as fibroids, polyps in the uterus, thickness of the uterine lining, and cysts in the ovaries.

In our consulting session, we offer real-time scanning so that the gynaecologist and patient can both look at the dynamic images at the same time and discuss the findings instantly. A treatment plan can then be formulated in the same consultation.

Alternatively, if you have already had an ultrasound scan arranged by your GP, please bring along your report and we can discuss the next treatment step based on the scanning result.

• Medical Treatment Review

Medical treatment of menorrhagia can be in formed of:

• simple oral medications that are only needs to be taken at the time of bleeding. Some have the added benefit of relieving painful menstrual cramps;
• hormonal treatment – They are particularly helpful in correcting hormonal imbalance and regulating menstrual cycles. Some gives bonus benefits of providing birth control; or
• a combination of both.

We go through your current medications and adjust the dosage, or recommend a new regime according to your specific condition.

• Hysteroscopy test and surgery – a same-day procedure for diagnosis and therapeutic treatment

This treatment package will help you to:

• rule out the rare possibility of cancer on the lining of the uterus;
• confirm the presence/absence of polyp or fibroid inside the uterus;
• remove any abnormal growth inside the uterus; AND
• have treatment of menorrhagia at the same time.

You may be particularly suitable for this treatment package if:

• you are over 35 years old and have irregular, frequent or very heavy periods;
• you have some irregular bleeding between the periods;
• ultrasound scan suggests polyp or fibroids inside the uterus; or
• your bleeding problem does not improve with medical treatment.

Part 1- Diagnosis
First of all, the gynaecological surgeon performs a hysteroscopy to carefully look inside of the uterus. A hysteroscope is a tiny, slender camera that goes through the vagina into the uterus and produces a video image of the uterine cavity on the TV screen.

Know more about Hysteroscopy

The surgeon will then obtain a biopsy at the lining of the uterus (endometrial biopsy), usually by a minor procedure called D&C. This is an important step to rule out cancer inside the uterus.

Part 2 - Treatment
Immediately after that, the gynaecologist performs one of the therapeutic procedures to reduce bleeding in the future:

• Insertion of a hormonal IUD (Mirena) - This intrauterine device locally releases a hormone called levonorgestrel, which makes the lining of the uterus thin and decreases menstrual flow and cramping.
• Hysteroscopic removal of polyp or fibroid (Hysteroscopic polypectomy or hysteroscopic myomectomy) – Any polyps or fibroids inside the uterus are removed immediately with special devices attached to the hysteroscope.
• Ablation/resection of endometrium – The lining of the uterus (endometrium) is carefully shaved off with a loop wire device attached to the hysteroscope, or destroyed by a special energy device. As menstrual bleeding is caused by shedding of the cells in this lining, removing this layer of tissue is one of the effective cures of heavy period problem.

These procedures may be done in the outpatient clinic, under regional anaesthesia, or after the patient being put to sleep (general anaesthesia). The decision is based on individual tolerance to specific procedures, previous vaginal birth, the likely cause of abnormal bleeding, and the planned therapeutic procedure.

• Removal of fibroids– Myomectomy

Fibroids are one of the most common causes of heavy menstrual bleeding. Unfortunately, there are no medications that can effectively permanently shrink or completely get rid of the fibroids. The only way of removing the fibroids is by surgery. Myomectomy means surgical removal of fibroids (myoma is the technical word for fibroid).

Fibroids can be removed using minimally invasive procedures or traditional open abdominal surgery.

Most gynaecologists in Australia perform myomectomy using traditional open abdominal surgery. The surgeon makes a “bikini line” incision (called laparotomy, usually about 8-15cm) in the lower abdomen to gain access to fibroids. It is currently the most commonly performed method of myomectomy, in part because fewer doctors are skilled at the less invasive approaches and fewer medical facilities have all the necessary equipment.

At our practice, we have replaced open myomectomy with laparoscopic (keyhole) surgery in most of our patients. Laparoscopic myomectomy is a minimally invasive procedure where the surgeon makes tiny incisions (typically 0.5 – 1.0cm) on the abdomen to remove the fibroids from the uterus. The fibroids are then taken out with a device (morcellator) that efficiently cuts the fibroid into small pieces and allows for removal through one of the small laparoscopic incisions. Occasionally, a “mini-laparotomy” is performed in a similar fashion to open surgery but with a much small wound after laparoscopic myomectomy to achieve an efficient removal of large fibroids from the body.

If the fibroids are small ones inside the cavity of the uterus, they can be removed with hysteroscopy as described above.

Know more about fibroids

Know more about myomectomy

• The Final Solution: Hysterectomy

Hysterectomy is surgical removal of uterus. It is the definitive cure of menstrual problems for women who have no desire for pregnancies in the future.. It offers an opportunity of improving quality of life and sex life, in particularly for women whose symptoms persist in spite of other treatments. It eliminates the chance that menstrual problems or new fibroids will recur.

Hysterectomy does not necessarily mean removal of ovaries. If women choose to keep the ovaries, they would still have normal hormonal cycles until the age of their natural menopause.

Same as myomectomy (see above), we are specialized in hysterectomy using minimally invasive techniques.

Know more about hysterectomy

Every women is individual and her situation requires an individual plan of management. If you think these issues relate to you, arrange a personal consultation with us to discuss your menstrual issues and know more about our treatment programmes.