What is a ‘normal period’?
In a normal period a woman’s uterus sheds a limited amount of blood usually less then 5 tablespoons or 80mls.
What is a heavy period?
A practical definition is excessive menstrual loss that has a significant impact on lifestyle or results in iron deficiency.
What is abnormal uterine bleeding?
Bleeding in between periods or excessively heavy periods with clotting and or pain is generally considered abnormal. Any vaginal bleeding after the menopause is also considered abnormal.
How common are heavy periods?
Heavy periods (also known as menorrhagia) have been shown to affect 1 in 5 women.
What are the causes?
Local causes include Fibroids, polyps, infections, endometriosis (where the cells that line the uterus are also outside of the uterus), adenomyosis (essentially endometriosis of the uterine muscle), endometrial hyperplasia (precancerous thickening of uterine lining) and cancer.
General causes includes bleeding disorders, chronic liver and kidney problems, thyroid disease.
Iatrogenic (self induced) non-hormonal IUDs (not Mirena), Anticoagulant medications e.g. Warfarin and Hormones.
Essential (no obvious cause found) – this is the most common group.
What is the usual work up?
- Menstrual History and examination along with Pap smear if appropriate
- Blood tests to check blood count, exclude pregnancy and check iron studies, thyroid function and how your blood clots
- Ultrasound examination of the uterus to check for intra-uterine pathology e.g. polyps, fibroids (this can be done in-house at Greenslopes Specialist Gynaecology)
- Hysteroscopy and curettage remains the gold standard for assessing the uterine lining but this requires a day surgery admission. A Pipelle biopsy endometrial biopsy can sometimes be a reasonable alternative and essentially performs a mini curettage and has the advantage of being done in the rooms without an anaesthetic (again this can be done in the rooms with Dr Land if suitable)
What are the treatment Options?
Drug treatment or surgery constitutes the mainstay of treatment. Other measures include dietary modifications and iron supplements. Factors influencing treatment include the need for contraception, patient preferences and contraindications
Medical treatment includes:
- Generally only effective while you are taking treatment
- Non steroidals (Ponstan)
- Antifibrinolytics (Cyclokapron)
- Hormonal therapy- Oral Progestagen (Provera or Primolut)
- Intrauterine Progesterone (Mirena)
- Oral Contraceptives
- Androgenic Antioestrogens (Danazol)
- GNRH agonists (Zoladex, Synarel)
Surgical treatment includes:
- Endometrial Curettage is diagnostic not curative (although may improve things significantly if polyps were an issue)
- Fibroid resection hysteroscopically or laparoscopically or via embolisation may improve heavy painful loss
- Laparoscopic Hysterectomy offers permanent relief from abnormal menstrual bleeding and pain
- Total laparoscopic hysterectomy ( or Robotic Hysterectomy) can now be achieved in almost all cases and requires only 1-2 nights hospitalisation with a rapid recovery period due to the small incisions required. This is now becoming increasingly popular as it offers the only sure guarantee of no further bleeding. Ovaries can be retained or taken depending on the reason for the hysterectomy and your preoperative discussions with Dr Land