MENORRHAGIA (PERIOD PROBLEMS) – SOLUTIONS, SURGERY AND SIDE EFFECTS

MENORRHAGIA (HEAVY PERIODS)
Heavy periods are a symptom, not a disease in itself. It affects at least 20% of women, and tends to become worse as one gets older, especially after the age of 35. It does not indicate that the menopause (cessation of periods) will occur in the near future, and this problem may persist for 20 years or more without help. 

It is diagnosed as a loss of more than 80 ml per cycle, and this can be measured by weighing pads or tampons. There is an increase in blood flow, often with clots, associated often with pain and other pre-menstrual symptoms.

CAUSES
Dysfunctional Uterine Bleeding (DUB) 
No specific abnormality is found. There may be an imbalance in the ovarian hormone levels, although the individual hormone levels may be in the normal range. It is thus a diagnosis of exclusion, once all other causes have been investigated.

Peri menopause (The time around the menopause)
As a woman approaches the menopause, ovulation may not occur, although the ovaries are still producing oestrogen. This causes the endometrium (lining of the uterus) to build up. There may be lack of menstruation for 2-3 months. When the oestrogen levels fluctuate downwards, there is a heavy withdrawal bleeding, which may be extremely massive, with flooding. This condition is termed Metropathia Haemorrhagica.

Fibroids (Leiomyomata)
These are benign hormone dependent tumours of the muscle of the uterus. They are very common and occur in over 50% of women. They are associated with heavy periods, and can vary between pin-head size and football size. Only the larger ones need removal, and when a woman reaches the menopause, they stop growing, unless she is still taking HRT.

Endometrial Polyp
This is tissue which forms on a stalk inside the uterus. The cause is unknown, but it acts like a foreign body, and can cause heavy periods and break-through bleeding.

Endometrial Hyperplasia
This is a thickening of the endometrium, due to an imbalance in the hormones that control the menstrual cycle.

Adenomyosis 
This is a condition where the roots of the endometrial glands grow into the muscle of the uterus. It usually also causes dysmenorrhoea and is similar to endometriosis

INVESTIGATIONS
Pelvic Examination 
An internal examination is performed to assess the size and shape of the uterus and other pelvic organs. A Pap smear can be taken at the same time Blood test can be requested to rule out anaemia.

Pelvic Ultrasound 
To assess the thickness of the endometrium and determine whether there are fibroids present. The ovaries can also be assessed

Hysteroscopy and Curettage
A hysteroscopy and curettage can be performed to make an exact diagnosis and to rule out cancerous changes

NON-SURGICAL TREATMENTS
Non-surgical treatments can offer some relief from period problems, and are of most benefit if a woman is still desirous of pregnancy. It must be realized that the treatments only work while being taken, and would need to be taken until the menopause is reached.

The Pill
The oral contraceptive pill reduces blood loss and pain and regulates the cycle. There can be weight gain, bloating and headaches and should not be taken after the age of 35 if you are still smoking, due to the increased risk of DVT, stroke and heart attack.

Oral Progestogens 
These are given for 21 out of 28 days of the cycle, and can reduce periods, but can lead to break-through bleeding, bloating and mood swings. These include Norethisterone (Primolut) and Medroxyprogesterone (Provera). Side-effects can include cardiovascular effects, such as DVT, stroke and heart attack, nervous effects, such as insomnia, fatigue, depression, dizziness and headache. There can also be irregular bleeding, rash, acne and weight gain.

Injectable Progestogens 
Medroxyprogesterone (Depo-Provera and Depo-Ralovera) can be given at 3 monthly intervals. In some cases, periods will cease but a large percentage have irregular break-through bleeding which can be difficult to control, and the effect can last up to 18 months. Side-effects include cardiovascular problems, such as DVT, stroke and heart attack, eye problems, irregular bleeding and bone loss.