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If you consistently experience menorrhagia, don't suffer in silence as there are simple treatments available through to surgically advanced robotic techniques.

Diagnosis of menorrhagia

To establish a diagnosis, your gynaecologist will initially take a history of your symptoms and perform a vaginal examination that may include the use of a speculum and a Pap smear if yours is not up to date. You may then be referred for an ultrasound scan, usually by a probe in the vagina (this allows closer examination of the womb and pelvic organs).

In some cases your gynaecologist will need a sample of the womb lining to rule out some of the potential causes. This test is called an endometrial sampling and can often be performed in the outpatient clinic with minimal discomfort.

If this is not possible then you may be admitted for a hysteroscopy instead (telescope investigation of the womb lining). A sample of the womb lining is also taken in most cases.

Treatment options for menorrhagia

The treatment for heavy periods will depend on many factors including your age, the underlying cause, and whether or not you also experience significant menstrual pain. However in general, treatments tend to be as follows:

Hormonal treatment

If the problem is due to dysfunctional uterine bleeding (hormonal imbalance) and you still wish to have children, then the main treatment is often to use birth control hormones in different forms.

Blood clotting medication

If you are in your forties and your family is complete, then the first treatment your gynaecologist may try is medication that promotes blood clotting (tranexamic acid). If this fails, using a progesterone-hormone-impregnated intrauterine device (IUD) may be suggested.

These treatments have significantly reduced the need for hysterectomy for simple menorrhagia cases in the last few decades.

Surgery options

Further treatments tend to be surgical and used where there is a complicating factor to the menorrhagia like fibroids, polyps, adenomyosis and endometriosis or cancer. Options are:

  1. The removal of fibroids through the abdomen or the removal of polyps or fibroids through the cervix
  2. Surgical removal of the womb lining (not recommended if you also have significant pain)
  3. Uterine artery embolization for fibroids
  4. Hysterectomy (removal of the womb and usually the cervix also)

The advent of minimally invasive (keyhole) hysterectomy by laparoscopy or more recently robotically has created a means to perform hysterectomy resulting in less pain, shorter hospital stay and faster return to normal activity when it is performed by experienced, appropriately qualified surgeons.

In particular, advances in robotics have increased the surgeon’s quality of view, precision and ergonomics, making more complex cases easier to perform.

Most wombs up to the equivalent size of a 4-month pregnancy can be safely removed by keyhole surgery in the hands of an appropriate expert. You should not just assume that open surgery is your only option, even if that is the only option offered to you.

Ref: S13