Heavy / Painful Periods
Heavy periods affect 4-9% and painful periods affect more than 45% of women in the UK. The causes of this conditions include fibroids, adenomyosis (where the lining of the womb ‘burrows’ into the underlying muscle), polyps in the womb, imbalance of prostaglandins in the lining of the womb, abnormal changes in the cells lining the womb (hyperplasia and rarely cancer), endometriosis and pelvic adhesions as well as problems outside the womb. These include thyroid and clotting problems.
With such a wide range of causes the diagnosis is usually made by a detailed history of the condition, careful examination and various combinations of ultrasound scanning, hysteroscopy and laparoscopy.
Treatments depend on the cause but include medication such as tranexamic acid which helps the blood to clot and thus reduces loss, mefanamic acid which reduces loss and is also a pain killer, the combined oral contraceptive pill, a hormone called norethisterone (taken from days 5-25 of each cycle) or the MIRENA coil.
Surgical treatments include ‘cauterisation’ of the lining of the womb using a device called Novasure, removal of fibroids affecting the cavity of the womb using an operating camera in the womb called an operative hysteroscopy, or removal of the womb (hysterectomy). Hysterectomy can usually be done as a keyhole operation called a Laparoscopic Hysterectomy. This procedure requires advanced laparoscopic training and the National Institutue for Health and Clinical Excellence (NICE) state ‘Advanced laparoscopic skills are required for these procedures, and clinicians should undergo special training and mentorship’. Do ensure you are aware of the experience of any clinician offering this procedure, who should be able to provide the number of procedures they have undertaken and their major complication rate.