Heavy Periods [Menorrhagia]

Heavy menstrual bleeding is a common reason for women to consult a gynaecologist. Heavy menstruation can result in significant distress and may affect a woman’s quality of life. AWARE can help you with full assessment and a range of management options for this problem.

There are numerous causes for heavy periods including:

• fibroids (benign, non-cancerous growths of the muscle in the wall of the uterus
• endometrial polyps (a benign growth of the lining of the uterus)
• endometrial hyperplasia (thickening of the lining of the uterus)
• adenomyosis ( a condition where the endometrium grows into the wall of the uterus causing it to enlarge)
• less common causes include: thyroid disorders, blood clotting disorders, cancer of the endometrium

The most common cause of heavy periods is an imbalance in the hormones oestrogen and progesterone which control growth of the lining of the womb (endometrium) and therefore effect menstruation. This hormonal imbalance is also known as ‘dysfunctional uterine bleeding’.

During your consultation you will be asked to provide information relating to your menstrual history in order to help ascertain the cause of heavy periods. The questionnaire (140kb) below is a useful starting point and it would be helpful if you could complete this prior to your appointment. It is also likely that you will require a gynaecological examination to assess the uterus and ovaries. A vaginal (internal) ultrasound may help with this assessment as well as in measuring the thickness of the lining of the womb. In some situations a small amount of endometrial tissue may be sampled using a tiny syringe, this tissue can then be sent to a pathologist for further investigation. Some women may require a blood test to check their blood count (haemoglobin) and iron levels or to assess their hormone levels.

You may be advised to have a further procedure known as a hysteroscopy and a dilatation and curettage (D&C or curette). This procedure is usually carried out under general anaesthesia as a day procedure. It involves a small ‘telescope’ called a hysteroscope which is introduced through the cervix to inspect the inside walls of the uterus. A D&C involves sampling a small amount of the lining of the womb and sending this sample to the pathologist for further investigation.

After the cause of heavy bleeding has been assessed then treatment is advised depending upon the underlying cause. There are now numerous conservative options available for the treatment of heavy periods. This may involve medical or hormonal treatments or the insertion of a progestogen containing intra-uterine device. At AWARE we encourage women to try these methods prior to surgical treatment however, if these methods are unsuccessful or unsuitable, then the following surgical treatments are available:

• myomectomy (removal of fibroids)
• endometrial ablation (removal of the lining of the womb with microwave or ‘balloon’ technology)
• hysterectomy (removal of the uterus), this may be done laparoscopically (keyhole surgery), via an abdominal incision or vaginally depending upon patient suitability

Download Questionaire (140kb)

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