This Clinician Blogging discusses heavy regular menstrual bleeding, also known as Menorrhagia.  We will discuss the following:

• What is Menorrhagia?
• What should I do if I think I have Menorrhagia?
• My examinations were normal, what now?
• What are the treatment options?
• Medications have not helped and I have been referred to a gynaecologist, what will happen now?
• What surgical treatment options are available?
• Further information

What is Menorrhagia?

Heavy regular bleeding (Menorrhagia) is defined as excessive blood loss during a woman’s period on several consecutive cycles, which interferes with a woman’s quality of life. Bleeding which occurs outwith the time of a woman’s period is dealt with in another blog.

What should I do if I think I have Menorrhagia?

If you think you are experiencing heavy regular bleeding during your periods (menorrhagia) then you should see you GP.  Your GP will want to know more about your cycle to determine if there is any underlying cause for excessive bleeding. Your GP will then perform an examination of the abdomen, cervix (using a speculum) and a pelvic examination. Your GP will also do a full blood count to check that your blood loss has not made you anaemic, if you are, this is treated with iron tablets. Your GP may wish to do other blood tests such as thyroid function tests if you are experiencing other symptoms.

My examinations were normal, what now?

If your examination is normal but you are still experiencing heavy regular periods you may wish to try some treatment options, there are several options available.

What are the treatment options?

• Tranexamic acid and mefanamic acid.

These medications are non-hormonal tablets which are taken at the time of a period to reduce blood flow and pain. These are a good option if you do not wish contraception or would prefer not to take hormones.  Common side effects include indigestion, diarrhoea and headaches. If these are effective, they can be continued indefinitely, if they are not effective within 3 months, they should be stopped.

For more information about these medications, please click one of the links below:

http://nhs.medguides.medicines.org.uk/nhs/medicine.aspx?name=tranexamic+acid&use=Blood%20clotting&preparation=1

http://www.patient.co.uk/medicine/Mefenamic-acid.htm

• Intrauterine system (IUS) also known as Mirena coil

An Intrauterine system or Mirena coil is a hormone-coated coil that can be inserted into the womb by your doctor. It acts to thin the lining of your womb to reduce bleeding. There can be some irregular bleeding to begin with, which can last up to 6 months. It is recommended to keep it in for at least 6
months before assessing the effect. A IUS lasts 5 years before it needs to be changed.  If you already have a copper coil, this can make bleeding heavier. You could either change it for a mirena coil, or take tranexamic acid/mefanamic acid at the time of your period as above.
For more information about this treatment option, please click the link below:

http://www.nhs.uk/conditions/intrauterine-system-(ius)/Pages/Introduction.aspx

• Combined oral contraceptive pill

Combined oral contraceptive pill provides contraception, gives good cycle control and can lessen the flow of bleeding. It is not suitable for smokers over 35yrs, or those with a history of migraine or DVT. If your period is lighter, but still painful, mefanamic acid can be added to this during the time of your period.

For more information about this treatment option, please click the link below:

http://www.nhs.uk/conditions/combined-contraceptive-pill/Pages/Introduction.aspx

• Progesterone only medicines
  Progestogen only medicines can also be effective.  Depo-provera is a contraceptive injection given every 12 weeks, most women have no periods at all on this. This is used in women under 40 years.

Norethisterone pills can be given on day 5-26 of your cycle or the Cerazette contraceptive pill can be taken daily. These methods may cause irregular bleeding initially. This usually settles within 6 months.

For more information about these treatment options, please click the links below:

http://www.patient.co.uk/health/Progestogen-Only-Pill.htm

http://www.patient.co.uk/health/Contraceptive-Injection.htm

All of the above should be reviewed after 3-6 months, and if ineffective, you may wish to consider an alternative medication, or your GP may refer you to a gynaecologist.

Medications have not helped and I have been referred to the gynaecologist, what will happen now?

The gynaecologist may wish to do further tests such as an ultrasound scan or a sample of the lining of the womb.  Your gynaecologist may then suggest some surgical procedures to help with heaving bleeding.

What surgical treatment options are there?

There are some surgical procedures that can be performed for heavy bleeding.  These include endometrial ablation (destruction of the womb lining), or rarely,
hysterectomy (removal of the womb). Neither of these would be 1st line treatment, and are generally only used if non-surgical methods (medications) are not effective.

For more information about surgical treatment options, please click on the links below:

http://www.patient.co.uk/health/Hysterectomy.htm

http://www.guardian.co.uk/lifeandstyle/besttreatments/endometrial-ablation-diathermy

http://www.guardian.co.uk/lifeandstyle/besttreatments/endometrial-ablation-microwave

Further information

If you would like more information about heavy periods (Menorrhagia), please click on one of the links below:

http://www.patient.co.uk/health/Heavy-Periods-(Menorrhagia).htm

http://www.nhs.uk/conditions/periods-heavy/Pages/Introduction.aspx

Refs
Heavy Menstrual bleeding. NICE clinical guideline 44. Jan
2007

The initial management of menorrhagia. RCOG evidence
-based guideline No. 1Oct 1998

---

Add this page to your favorite Social Bookmarking websites