Heavy menstrual bleeding (previously called Menorrhagia) is a condition where a woman can have heavier than normal bleeding or the duration of her periods can be longer than normal. It is very rare that a woman becomes anaemic but feeling tired, getting dehydrated are common symptoms of heavy menstrual bleeding. To read more on heavy menstrual bleeding and its causes, please visit our article ‘Heavy menstrual bleeding (Menorrhagia) – causes’.
Diagnosis of heavy menstrual bleeding
Once you present yourself to a good gynaecologist near you or your family gynaecologist, diagnosis would start with a series of questions including the duration of bleeding, the quantity of blood lost and how frequently you had to change your sanitary pads/ tampons or menstrual cups, depending on what you use.
After that, a few tests may be required to get to the root cause of the problem. Such tests include:
- Blood test – To look for levels of haemoglobin, thyroid disorders and blood clotting issues
- Pap Test – Cells or tissue sample from the cervix may be taken and sent for testing to see if there are any precancerous or cancerous cells present.
- Endometrial biopsy – Endometrium is the inner lining of the uterus. A small piece of this lining is taken and sent for biopsy to look for presence of any cancerous cells.
- Ultrasound test – This is done to look at ovaries, uterus and other organs in the pelvis region. Your doctor will be able to see if there are any unwanted growths such as growth of endometrium on the outside of uterus, or presence of polyps or fibroids that could be causing heavy menstrual bleeding.
- Sonohysterography – A specific fluid will be injected into the uterus and with the help of ultrasound, the imaging of uterus is done to look for issues with the endometrial layer.
- Hysteroscopy – Hysteroscope is a tiny tube with light and camera at the tip of it. It is inserted into the uterus through the vagina. The captured imagery is projected onto a TV like display that allows your gynaecologist to look for any abnormalities inside the uterus.
A test to check the levels of estrogen and progesterone might also be required by your gynaecologist to see if there is an imbalance. Hormonal imbalance can also cause heavy menstrual bleeding as the endometrial layer thickens (than usual) during the menstrual cycle.
Treatment of heavy menstrual bleeding
Treatment depends on the severity of bleeding and on the cause detected during diagnosis.
Medication will be provided to tolerate the pain caused by abdominal cramps and also to reduce the bleeding during periods. Hormone IUD or hormone related contraceptives / pills will be given to balance the hormones, estrogen and progesterone of that is found to be the cause of heavy menstrual bleeding.
If you are also suffering from anaemia, then iron supplements with good nutrition will be advised.
Dilation and Curettage (D&C) procedure
In this procedure, the cervix is dilated and the endometrial layer is scraped or sucked out to reduce it’s thickness. As said previously, when there is hormonal imbalance, the thickness of endometrial layer increases that results in heavy bleeding during periods. Large clots may also drop from the uterus.
Uterine artery embolization
Uterine artery embolization is performed when fibroids are detected. The idea behind this procedure is to cut off the blood supply to the fibroids so that their growth will be arrested. In order to perform the procedure, a thin catheter is passed through the large artery in the thigh (called femoral artery) and once the uterine artery is reached, special material is injected that stops the blood supply to the fibroids
Myomectomy is the procedure done to remove fibroids surgically. The most preferred method of surgical removal of fibroids is through laparoscopy procedure. Laparoscopy procedure involves making tiny incisions on the abdomen through which few tubes are inserted into the abdomen and the fibroids are removed. The procedure is quick, relatively less painful and heals quicker than conventional method of removing fibroids. Know more about Myomectomy here.
If your gynaecologist feels that the fibroids can be reached and removed through the vagina, a simpler procedure is done wherein a hysteroscope is used to remove them. This procedure doesn’t require any incisions to be made.
Focused ultrasound surgery
Powerful ultrasound energy is focused onto the fibroid as a result of which the tissues inside the fibroid die and the fibroid shrinks. This procedure doesn’t require any incision to be made.
The endometrial layer is destroyed using laser or radiofrequency emitting devices. After destroying the endometrial layer, the periods will be lighter as there isn’t much endometrium to shed.
A electrosurgical wire loop is used to remove the inner lining of the uterus. This is similar to endometrial ablation. This is performed in women who are not expecting to get pregnant anymore in the future.
This is an ultimate procedure wherein the uterus of the woman is removed. Depending on the need, regular hysterectomy (removal of only uterus) or radical hysterectomy (removal of uterus, ovaries and fallopian tubes) is performed. Dr. Deepa Ganesh at DG Laser & Cosmetic Gynecology is one of the top and most preferred gynecologists in Chennai to perform laparoscopic hysterectomy. She is the first person in South India to perform robotic hysterectomy using CMR Versius Robotic Surgical System.