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Heavy Painful Periods...

 

Heavy Periods (menorrhagia)

This is defined as menstrual loss of greater than 80 mls with each period. It affects more than 1 in 5 women. Heavy periods is one of the most common causes of iron deficiency anaemia in western women.


Periods are considered to be heavy when:

 

Menstrual flow that interferes with your regular activities e.g. becoming house bound due to the heavy periods

 

Periods that last longer than eight days

 

Menstrual flow that soaks through one or more tampons or napkins every hour for several consecutive hours

 

Menstrual flow that includes large blood clots  

 

Anaemia causing tiredness 

 

Causes of heavy periods

The commonest cause in the younger age group is due to an hormonal imbalance or dysfunctional uterine bleeding (DUB).


Pelvic pathology

Fibroids

 

Endometriosis

 

Pelvic inflammatory disease

 

Uterine Polyps 


Investigations

Blood tests - to exclude anaemia

 

Ultrasound scan - To exclude uterine polyps or fibroids. Assessment of the ovaries are also made

 

Endometrial biopsy - a sample of endometrial tissue that is obtained to be examined under a microscope

 

Hysteroscopy- Assessing the lining of the uterus 

 

Treatment

This is based on the patient's age, contraceptive wishes and the severity of the heavy periods.


Medical

Oral contraceptive pill

 

Tranexamic acid

 

Mirena coil 


Surgical

By removing the lining of the uterus by ablation ie. Novasure Endometrial ablation. This procedure has a high success rate and may be performed under sedation with local anaesthetic.


Hysterectomy

Laparoscopic (key hole surgery)

 

Abdominal

 

Subtotal or partial (conserving the cervix)

 

Vaginal 

 

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