Why am I coming to this clinic?

You have been referred to this clinic because of the problems you have been experiencing with your periods.

What is Menorrhagia?

Menorrhagia is the medical name for heavy and prolonged periods.

Cause of heavy periods

Although heavy periods are common they are rarely due to serious disease. Anything that makes the womb larger leaves a bigger area to bleed from, which can be associated with heavy loss.

Fibroids, (simple harmless lumps of gristle in the womb) can make the uterus larger and increase menstrual loss.

A condition known as ‘adenomyosis’ (when glands in the layer lining the uterus get blocked in the uterus) can also cause the uterus to enlarge and cause uncomfortably heavy periods.

Bleeding from the uterus is influenced by hormones. It is therefore easy to understand that any abnormality of the female hormones or the way that the uterus responds to them can also be associated with heavy periods.

Inflammation of the uterus also causes heavy periods. The uterus can be inflamed due to a previous infection or an irritant device put in the uterus (such as a contraceptive coil).

What will happen at the appointment?

The specialist will take details of your symptoms. It is helpful if you have a record of your last menstrual period, cervical smear and any medication that you are taking regularly. Your consent will be taken for any procedure needed at this appointment. You will be able to ask any questions you may have. You do not need to cancel your appointment if you are having a period.

It is advisable to eat and drink normally before your appointment.

Doing all the tests at one visit

Whenever possible we will undertake all tests in one visit, but will do whatever suits you. You may also have an internal examination, which is not usually painful and only lasts for a minute or so. You may wish to take your usual painkiller beforehand eg. paracetamol or ibuprofen. We try to make all internal examinations as dignified and comfortable as possible.

Will I be examined?

Your cervix is checked for any abnormalities by inserting a small instrument called a speculum (used for smear tests) into your vagina.

You may be advised to have a hysteroscopy examination to look inside the womb. This is usually performed in the clinic on the same day.

What is a hysteroscopy?

A hysteroscope is a small instrument containing a tiny camera, which is inserted into the vagina and into the womb (uterus). A local anaesthetic is used to numb the area if necessary. The specialist will see a clear view inside the uterus, which will help in obtaining a diagnosis and deciding upon the best treatment for you.

Sometimes a small sample of the womb lining may be taken. This may cause some period type cramps, which will soon pass. The sample will be sent to the laboratory for examination.

If the doctor feels that the examination would be too difficult or uncomfortable, you may be asked to come back another day to have the hysteroscopy performed under a general anaesthetic (while you are asleep) in the day surgery unit. You may be given a date for this before going home.

Are there any risks?

Hysteroscopy is a common and straight forward procedure. However, as with any surgical procedure there is a small chance of side-effects or complications. Women who have had previous surgery on their womb eg caesarean section, myomectomy (an operation to remove fibroids from the wall of the womb) or surgery to the cervix have a slightly increased risk of complications.

Common side effects include:

  • Vaginal bleeding or spotting
  • Period like pain

Rare but more serious complications include:

  • A risk of the telescope making a small hole in the womb
    (seven in every 1,000 procedures). However, even if this did
    happen you would only have to stay in hospital overnight for
    observation and take a short course of antibiotics
  • Pelvic infection

After the examination

It is normal to have some vaginal spotting or bleeding, which can last one to three days. It is advisable to rest for the day after this procedure. You may also experience some period type pains for the next day, so take your usual over the counter pain relief, for example, paracetamol or Ibuprofen.

Treatment

Treatment depends on your age and how much trouble the periods cause. For example, if you are 51 (the average age of the menopause) then it is worth considering simple treatments in the hope that the menopause will bring a natural cure. However, if your periods are heavy and intolerable and you are only 30, we have to consider that you probably have another 20 years of menstruation ahead of you.

It is important to appreciate that heavy periods are not a disease and therefore the treatment is designed to make life
more comfortable for you. This means you have to decide in your own mind whether any potential inconvenience associated with treatment is worth the relief it brings. The main purpose of this page is to introduce you to the various therapies to help you decide what is right for you.

Treatment is best divided into:

  • Alternative medicine
  • Simple therapy during periods
  • Hormonal medicine
  • Surgery:
    • Endometrial Ablation (removal of lining of the womb)
    • Hysterectomy

Will I be offered any treatment on the day?

The doctor may suggest you have a Mirena coil, which may be fitted on the day. This is a small T shaped plastic device that sits inside the womb. The coil releases a hormone, which prevents the lining of the womb from building up, either by stopping your periods or making them much lighter. The Mirena coil can take up to six months to be fully effective.

Alternative treatments will be fully discussed with you at your visit.

More information

This information page is intended to provide you with information and to give you some background to ask further
questions. You might like to experiment with different medical options. However, if a surgical solution is applicable to you there are information leaflets which cover these options in more detail.

If you have any questions or concerns about your appointment or treatment please contact:

Jasmine Ward
Telephone: 01935 384385

Ref: 14-15-124
Review: 11/17