stephenquinn

Obstetrician and Gynaecologist

Heavy and/or irregular bleeding are relatively common problems which can have a huge effect on a woman's quality of life. Heavy menstrual bleeding (HMB) is a prevalent condition that affects 20–30% of women of a reproductive

age. In about half of women with heavy menstrual bleeding, no underlying reason is found, however there are a number of potential causes most of which are benign and easily treated:


Fibroids

Endometriosis/adenomyosis

Hormonal changes

Endometrial polyps

Infection

Breakthrough bleeding with hormonal contraception

Less commonly pre-cancerous or cancerous change


Investigations


Persistent abnormal bleeding should always be investigated and tests may include:

Swabs for infection

Cervical smear (‘Pap’ test)

Pelvic ultrasound scan

Hormone blood tests

General haematology blood tests

Hysteroscopy (a small telescope is used to check inside the womb)


Treatments:


Treatment will depend on the underlying cause, however it’s also important to consider what impact symptoms are having on quality of life. Where tests are reassuring and symptoms are manageable it may be appropriate to do nothing as often over time menstrual cycles can go back to normal.


Options are divided into conservative (‘wait and see’), medical treatments or surgical. In many cases several different treatment approaches may be available and ultimately the option that is most acceptable to you as an individual will be the right choice.


Medical treatments


Hormonal contraceptives eg the pill or the Mirena ( a hormone releasing coil)


Progesterone taken cyclically or in some cases as needed


Tranexamic acid, non-hormonal treatment which can reduce menstrual blood loss by 50% and is only taken on the days of heavy bleeding


Mefenamic Acid, a non-steroidal anti-inflammatory drug that helps with pain and bleeding


Surgical treatments


Hysteroscopic surgery – problems like polyps or fibroids within the cavity of the womb can be removed very simply using a small telescope as a daycase procedure


TCRE (sometimes called endometrial resection or ablation) – these procedures are performed in the same way as for treatment of polyps or fibroids but instead to remove or destroy the whole of the lining of the womb. The aim of these procedures is to stop bleeding completely and permanently and are clearly only appropriate for women who have completed their family.


Laparoscopic or open myomectomy – surgical removal of fibroids while preserving fertility.


Laparoscopic or open hysterectomy – surgical removal of the womb which is a definitive treatment for abnormal bleeding



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