Heavy Menstrual Bleeding

Heavy menstrual bleeding (HMB) is a common condition. Also called heavy periods or menorrhagia, HMB affects one in five women in Australia and New Zealand.

Causes Of Heavy Menstrual Bleeding

Dysfunctional Uterine Bleeding
If no abnormality of the uterus is found, then the condition is called ‘dysfunctional uterine bleeding’. More than half of women with HMB have dysfunctional uterine bleeding.

Fibroids

These are benign (non-cancerous) growths of the muscle and connective-tissue cells in the wall of the uterus. They are found in up to one in three women.

Endometrial polyps

These benign growths occur on the lining of the uterus. They may also lead to spotting between or after periods.

Endometrial hyperplasia

This is a thickening of the lining of the uterus (endometrium) that leads to heavier bleeding.

Adenomyosis

This is an enlargement of the uterus caused by growth of the endometrium into the wall of the uterus.

Diagnosis and Tests

The following tests may help find the cause of HMB:

  • an internal vaginal examination to feel the size of the uterus
  • a blood test for haemoglobin levels.
  • an ultrasound scan to examine the lining of the uterus in women who have a higher risk of endometrial hyperplasia or uterine cancer.

Medical Treatments for Heavy Menstrual Bleeding

Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs are medications that reduce heavy bleeding. On average, NSAIDs reduce menstrual blood loss by about one-third.

Oral contraceptive pill: the pill usually reduces menstrual blood loss by a little more than a third. Side effects may include nausea, breast tenderness and headaches.

Oral progesterone (progestogen)

Tranexamic acid: Tranexamic acid may reduce menstrual blood loss by about half.

Danazol: Danazol may reduce menstrual blood loss by about two-thirds and may cause some women to stop menstruating. Possible side effects include weight gain, acne, hirsutism (male-patterned hairiness), hair loss and deepening or hoarse voice.

Progestogen intrauterine device: Placed into the uterus via the cervix, this device steadily releases tiny amounts of Progestogen.

Nearly all women will experience a large reduction in their blood loss (on average, a 94% decrease in blood flow). The treatment usually takes several months to achieve the desired effect. It appears to be the most effective drug treatment of HMB. Added benefits are reliable contraception and no need to take tablets.

Surgical Treatments For Heavy Menstrual Bleeding

Endometrial ablation: This is the surgical removal or destruction of the lining of the uterus using a hysteroscope, an instrument that is inserted into the cavity of the uterus through the vagina and cervix.
The procedure is performed under general or local anaesthesia, and women are usually able to go home the same day. It's effectiveness is high. About 85 of every 100 patients report a significant improvement. However, an improvement may not be long lasting for some women.

Myomectomy: This is surgical removal of fibroids while retaining the uterus. It's precise effectiveness in reducing HMB has been a matter of debate.

Hysterectomy: This is the removal of the uterus. The operation can be done in one of four ways.     

  • Abdominal hysterectomy
  • Vaginal hysterectomy
  • Laparoscopically assisted vaginal hysterectomy
  • Laparoscopic hysterectomy