Heavy Periods / Painful Periods
Heavy and Painful periods have an impact on many women’s lives. It is one of the most common gynaecological clinical problems, one in 20 women aged 30-49 consult their doctor each year with Heavy and Painful periods. One in five women in the UK will have a hysterectomy before the age of sixty.
The diagnosis of heavy periods is notoriously difficult. It is subjective and depend on the patient's history as only 40% of women with convincing history for menorrhagia will have excessive loss of >80ml/cycle. Therefore, it is important to be seen by a specialist to properly assess the menstrual blood loss. It is very important to make the right diagnosis for the appropriate treatment options as about half of all women who have a hysterectomy for heavy and painful periods have a normal uterus removed. On other hand, other medical treatment for heavy and painful periods is unlikely to be effective in those with normal blood loss.
Drug options:
There are wide variations in the drugs prescribed in general practice for the management of menorrhagia. The success rate ranges between 20% to 90%. Drug therapy for menorrhagia should be tailored to the individual. Factors taken into consideration when selecting the appropriate medical treatment include the patient's age, coexisting medical diseases, family history, and desire for fertility. The most commonly used medicine are:
Endometrial ablation is a procedure that burn (ablates) the lining of the uterus in women with heavy periods. It is rigorously evaluated for years. It is now well proven and reliable, however, it needs to be performed by a specialist. The actual active treatment time is 3 minutes and total operative time is short approximately 15-20 mins. It can be undertaken under general on local anaesthesia. The success rate in reduction of menstrual loss is close to 90%. Approximately 40% of women with successful results their periods will stop. The procedure's complication rate is low. Unfortunately it is not suitable for every woman, therefore each individual needs to be assessed by specialist prior to the surgery.
The contraindications for endometrial ablation are:
Post Procedure
Patients should be advised that the common post operative side effects of ablation are cramping and a vaginal discharge. You may have some vaginal bleeding / discharge for a few days and a watery discharge for up to three to four weeks and uterine cramping may persist for 24-72 hours. Most women can resume normal activities after one to two days.
Hysterectomy (removal of the uterus), the traditional surgical treatment for heavy periods, is only suitable for women who have no further wish to conceive. The operation itself is not without risk. However, laparoscopic (keyhole) hysterectomy is undertaking by laparoscopic specialist has many advantages; rapid, safe, shorter time, fewer complication, less post operative pain, with faster recovery comparing to open tummy hysterectomy.
The diagnosis of heavy periods is notoriously difficult. It is subjective and depend on the patient's history as only 40% of women with convincing history for menorrhagia will have excessive loss of >80ml/cycle. Therefore, it is important to be seen by a specialist to properly assess the menstrual blood loss. It is very important to make the right diagnosis for the appropriate treatment options as about half of all women who have a hysterectomy for heavy and painful periods have a normal uterus removed. On other hand, other medical treatment for heavy and painful periods is unlikely to be effective in those with normal blood loss.
Drug options:
There are wide variations in the drugs prescribed in general practice for the management of menorrhagia. The success rate ranges between 20% to 90%. Drug therapy for menorrhagia should be tailored to the individual. Factors taken into consideration when selecting the appropriate medical treatment include the patient's age, coexisting medical diseases, family history, and desire for fertility. The most commonly used medicine are:
- Nonsteroidal anti-inflammatory drugs
- The average reduction rate of 20-40% in menstrual blood flow. It is used during menstrual bleeding
- The most common adverse effect of stomach upset.
- Tranexamic acid
- Tranexamic acid’s mechanism of action is by prevention of breakdown of clots at the level of the lining of the uterus.
- The average reduction rate of 40% in menstrual blood flow
- Common adverse effects include menstrual discomfort, headache, and back pain.
- Oral contraceptive pills
- Oral contraceptive pills (OCPs) are a popular first-line therapy for women who desire contraception.
- The average reduction rate of 40-50% in menstrual blood flow
- Common adverse effects include breast tenderness, breakthrough bleeding, nausea, and, possibly, related weight gain in some individuals.
- Progesterone only therapy
- Progesterone is commonly prescribed medicine for menorrhagia.
- Therapy results in a significant reduction in menstrual blood flow when used alone, over 60%.
- Common adverse effects include weight gain, breast tenderness, headaches, edema, and depression.
- Levonorgestrel intrauterine system (Mirena coil)
- Reduces menstrual blood loss in 85% of women within 6 months and in over 90% by end of first year.
- It is very effective contraception which last for 5 years.
- Adverse effects of Mirena include uterine bleeding or spotting, rarely headache, breast tenderness, skin/hair changes
- Gonadotropin-releasing hormone agonists
- These agents are used on a short-term basis due to high costs and severe adverse effects.
- GnRH agonists are effective in reducing menstrual blood flow.
- A prolonged hypoestrogenic state leads to bone demineralization (Osteoporosis).
Endometrial ablation is a procedure that burn (ablates) the lining of the uterus in women with heavy periods. It is rigorously evaluated for years. It is now well proven and reliable, however, it needs to be performed by a specialist. The actual active treatment time is 3 minutes and total operative time is short approximately 15-20 mins. It can be undertaken under general on local anaesthesia. The success rate in reduction of menstrual loss is close to 90%. Approximately 40% of women with successful results their periods will stop. The procedure's complication rate is low. Unfortunately it is not suitable for every woman, therefore each individual needs to be assessed by specialist prior to the surgery.
The contraindications for endometrial ablation are:
- Pregnancy or the desire to be pregnant in the future.
- Known or suspected endometrial cancer or pre-cancer.
- Desire to preserve fertility.
- Active pelvic inflammatory infection.
- Intrauterine device in place.
- Pervious surgery that could lead to weakening of the wall of the uterus
- Post-menopausal women.
- Abnormal development of the uterus.
- A woman with a uterine cavity of a length is less than 6cm or greater than 10-12cm.
Post Procedure
Patients should be advised that the common post operative side effects of ablation are cramping and a vaginal discharge. You may have some vaginal bleeding / discharge for a few days and a watery discharge for up to three to four weeks and uterine cramping may persist for 24-72 hours. Most women can resume normal activities after one to two days.
Hysterectomy (removal of the uterus), the traditional surgical treatment for heavy periods, is only suitable for women who have no further wish to conceive. The operation itself is not without risk. However, laparoscopic (keyhole) hysterectomy is undertaking by laparoscopic specialist has many advantages; rapid, safe, shorter time, fewer complication, less post operative pain, with faster recovery comparing to open tummy hysterectomy.