Gynaecology Services - Menorrhagia

Menorrhagia is a common condition which is illustrated by heavy menstrual bleeding.

When the blood loss lasts more than 7 days or is greater than usual, doctors like Sydney Specialist Gynaecologist call it menorrhagia.

Treatment

Until recently, the most common surgical option for treatment was hysterectomy. With the introduction of more convenient diagnostic procedures, gynaecologists are finding that many medical therapies (non operative) may be of value. These include:

• Non-steroidal anti-inflammatory drugs (NSAID's).

These drugs modify prostaglandin synthesis and can reduce bleeding by up to 20%. They have minimal side effects and can be bought over the counter.

• Tranexamic acid (Cyklokapron).

This drug affects the thrombolytic and fibrinolytic aspects of menstrual blood loss and can reduce bleeding by up to 30 or 40%. It has minimal side effects but one has to take 8 tablets a day during menstrual periods.

• Progesterone.

This induces an atrophic (thin) endometrium. Depending on how it is taken, it can regulate the menstrual cycles and/or decrease the flow.

• Oral contraceptive pill (OCP).

The pill can not only regulate the cycles but can decrease the flow as well. It contains Oestrogen and Progesterone and needs to be taken on a daily basis.

• Progesterone containing IUCD (Mirena).

This is an intra-uterine contraceptive device (IUCD) and induces an atrophic (thin) endometrium. It can reduce bleeding by over 90% but the most common side effect is abnormal spotting or bleeding that could last for up to six months.

Surgical treatment

The last 20 years have seen a growing interest in less invasive surgical solutions to a hysterectomy for the common problem of heavy bleeding. The principle is to cause scarring and adhesions within the endometrium and, therefore, alters menstruation. Recently, most interest has centred around electro-cautery ablation of the endometrium, microwave ablation (MEA) or heat therapy (Novasure).

• Endometrial ablation.

This procedure is designed for women who are not keen on, or have contra-indications to medical therapy or where medical therapy has failed. This is done as a Day Only procedure under general anaesthetic. The general success rate is rather high, at about 80%. Approximately 40% will have no bleeding and another 40% will have a significant reduction in bleeding. Various methods can be used and, currently, the microwave ablation (MEA) or the Novasure are the most popular, easiest to perform and have the least complications.

• Hysteroscopic myomectomy.

If a patient has submucosal fibroids in the uterus, then some of these fibroids may be able to be removed with a hysteroscope and also done as a Day Only procedure. If the fibroids are the cause of the heavy bleeding, then the reduction in bleeding will be remarkable.

• Hysterectomy.

This is done as a last resort for heavy bleeding and can be done in three ways:

• Vaginal hysterectomy
• Abdominal hysterectomy
• Laparoscopic hysterectomy