Treatment for Heavy Bleeding

Heavy vaginal bleeding also called menorrhagia, is a common health issue especially after age 40.

How can heavy bleeding be treated?

Heavy periods can be caused by many factors so treatment starts with diagnostic investigations that can include:

• A pelvic examination,
• A Cervical Screening Test and or colposcopy to exclude cervical causes for bleeding, and
• A pelvic ultrasound examination.

Management options will depend on the patient’s preference, but also on the clinical situation. These can include:

• Hormonal
• Non- hormonal option like tranexamic acid or NSAID medication
• Endometrial Ablation 
• Hysteroscopy removal of the polyp or submucosal fibroid
• Hysterectomy

Hormonal treatments

• Oral contraceptive pill.
• Progesterone only pill or mini pill
• NuvaRing
• Depo Provera Injections
• Mirena or Kyleena IUD
• Implanon

Non hormonal treatments

• Tranexamic Acid
• NSAI like Ibuprofen, Naproxen, Mefenamic acid

Surgical treatments

• Hysteroscopy with removal of polyps or submucosal fibroids
• Endometrial ablation
• Myomectomy
• Hysterectomy

Hysteroscopy

In many cases, a day surgery procedure “Hysteroscopy with dilation and curettage” may be required to diagnose and often treat any disease such as removal of small polyps or fibroid growths. 

Endometrial Ablation

With an endometrial ablation the endometrium or lining of the uterus is destroyed with heat.  There are several methods eg rollerball, microwave, Thermal Balloon or radio frequency ablation(Novasure)

Hysterectomy

A hysterectomy is a surgical procedure to remove the uterus. It offers a complete cure from menstrual bleeding but involves major surgery and a period of recovery.

If a hysterectomy is performed, the ovaries can be left in, thus creating no immediate hormonal side effects or need for hormone replacement therapy. The ovaries can be removed at the time, however individual risk factors including age, family history and past medical history would need to be considered.

Myomectomy

Myomectomy involves removal of the fibroid only through laparoscopic or open approach. This is done in an operating theatre under general anaesthetic and requires one to two nights stay in the hospital. This procedure is done to remove fibroid but preserve uterus or preserve fertility or ability to carry pregnancy.