The treatment for heavy periods, depends upon the cause. This is often difficult or impossible to determine. Drugs will usually be tried first in an attempt to reduce the blood loss, along with iron tablets if you are anaemic.

If drug therapy has not helped, and any other general disorders have been dealt with (such as an underactive thyroid), an operation may be necessary. This is only of course in women who no longer wish to have children. Possible operations are hysterectomy, transcervical endometrial resection (TCRE) and endometrial ablation.

Hysterectomy
This operation is 100 % effective in stopping heavy bleeding. It is the ‘gold standard’ against which all other medical and surgical forms of treatment are judged. The womb including the cervix is removed through a low ‘bikini line’ abdominal incision, or, less commonly, through the vagina. The vagina is left the same length, normal lubrication occurs and orgasm is still possible after the womb has been removed.

Hysterectomy requires a hospital stay of about five to seven days and convalescence of about six weeks. As with all major operations, complications can occasionally arise, although most of these are minor. Before a hysterectomy is carried out, it is important for you to accept that you will not be able to have children afterwards and that you do not mind your womb being removed. Some women do find this a difficult thing to accept.

Whether or not the ovaries are left in place at the time of hysterectomy will depend upon your age and your own personal feelings as well as whether any abnormality such as cysts or endometriosis are present. If your ovaries are removed you will usually be offered hormone replacement therapy (HRT), in the form of oestrogen. This will prevent you experiencing the short- and long-term problems of the menopause. HRT is particularly straightforward for women who have had a hysterectomy. Such women do not need to take the progestogen part of the HRT treatment cycle which can cause unpleasant side-effects. Your gynaecologist will discuss this aspect fully with you before the operation is carried out.

Hysterectomy is a major operation, but if you need the operation and are happy to have it carried out, you should be very pleased with the outcome. Most women express no regrets and a large majority of women ‘wish they had had it done years ago’. Providing the cervix was normal, there will never be the need for another smear.

Endometrial resection (TCRE) and ablation
These are new operations by which the gynaecologist aims to remove as much as possible of the lining of the womb through the cervix. This has the advantage of not leaving a scar. It has the effect of either reducing the blood loss with each period or, less commonly, stopping the periods altogether. About 50-75 % of women find TCRE or ablation improves their problem. As yet we do not know for how long this relief will last.

Prior to the operation it is common for a hormonal drug to be prescribed to stop the period cycle and make the lining as thin as possible. This treatment would normally be given for about six weeks. A general anaesthetic is required, but the hospital stay is usually only one or two days and convalescence only about a week.

In TCRE the womb lining is inspected using a hysteroscope. This is inserted through the cervix and then the lining is ‘stripped’ off using a hot wire (diathermy) loop or a hot revolving metal ball (rollerball). In endometrial ablation the lining is destroyed using a contact laser to burn away the tissue. Complications can occasionally occur but are no more common than with hysterectomy. After TCRE or endometrial ablation women should not regard themselves as sterile. Sometimes a sterilisation operation is carried out at the same time.

As TCRE and ablation are less ‘major’ surgical procedures than hysterectomy, some women find them more acceptable. They are not suitable procedures for everyone with heavy periods, especially those in which fibroids are the cause. They are also not suitable operations for women wishing to have children.

There are other new operations now being carried out and their place in the treatment of menorrhagia is still being evaluated. Your gynaecologist will advise you about these. There are other new operations being carried out such as thermal balloon ablation (Cavaterm).

Myomectomy
This is not a common operation. During myomectomy fibroids are removed from the wall of the womb which is then repaired and the womb left in place. This operation is sometimes used when the periods are heavy and the woman still wishes to have children, or does not want her womb removed. However, it is as ‘major’ an operation as hysterectomy. As it is impossible for every fibroid to be removed (some may be too small to be discovered), there is of course no guarantee that a hysterectomy might not eventually be required since as often happens further fibroids may grow and develop..

What are the risks?
Any operation may lead to problems including the following general risks:

• injury to nearby areas (tissue) and excessive bleeding;
• infection;
• allergic reaction to drugs or anaesthetic;
• breathing difficulties;
• a recurrence of the problem.

A hysterectomy carries with it the following risks:

• change in sex drive;
• weight gain;
• constipation;
• hot flashes, (if your ovaries have been removed);
• potential increase in risk of heart disease if you do not have HRT.

The likelihood of complication increases in the following:

• the overweight, smokers and heavy drinkers;
• users of medicinal and mind altering drugs.

When comparing the various treatment methods, the following statistics may help:

• Damage to local tissue, such as your ureter, bladder and bowel occurs in 1.5% of women, who have had vaginal hysterectomy; in contrast to 2.3% who have had abdominal hysterectomy.
• Up to 47% of women undergoing hysterectomy experience complications, (such as urinary tract infection or wound infection). In contrast, 4-5% of women did so after endometrial resection or ablation.
• Patient satisfaction after one year rates at 96% following a hysterectomy; 86% following ablation; and 79% following endometrial surgery.

Your doctor will help you decide between the advantages and the risks of this operation.

Related posts:

1. How does a woman know her periods are heavy?
2. Treatment For Fibroids
3. Hysterectomy
4. Treatment For Varicose Veins
5. Fibroids
6. Treatment For Miscarriage In Pregnancy