Summary

• When and why will my doctor send me to the hospital?
• What other causes are there of heavy menstrual bleeding?
• What tests are done at the hospital?
• How is heavy menstrual bleeding treated?

Q: When and why will my doctor send me to the hospital?

If any of the initial tests are abnormal or treatment with tablets has not been successful your GP will seek help at Brighton and Sussex University Hospital . Equally if you feel that the IUS will not suit you, your GP will refer you to discus other treatment options.

Q: What other causes are there of heavy menstrual bleeding?

Sometimes the initial investigations by your own doctor may make him suspect one of the following conditions. It is often difficult to make an exact diagnosis without further tests.

Other causes
These are less common. They include the following:

• Fibroids. These are benign (non-cancerous) growths of the muscle of the uterus (womb). They often do not cause problems, but sometimes cause symptoms such as heavy periods.
• Endometriosis. This can cause heavy and or painful periods as well as generalized pelvic pain and pain with intercourse. The lining of the womb grows outside the uterus.
• Pelvic Inflammatory Disease. This infection of the reproductive tract can lead to irregular and heavy periods with chronic pelvic pain if left untreated.
• Endometrial hyperplasia and cancer. These conditions are uncommon causes of heavy bleeding and cancer of the lining of the womb occurs in a small number of women, usually over the age of 40.
• Hormone problems. Periods can be irregular and sometimes heavy if you do not ovulate every month. Also in the years close to the menopause, periods can become heavier and/or irregular. An underactive thyroid gland may possibly cause heavy periods.
• The IUD (Intrauterine Device or 'coil') in the past sometimes caused heavy periods. However, a special hormone-releasing IUD can actually treat heavy periods (see below).
• Warfarin or similar medicines interfere with blood clotting. If you take one of these medicines for other conditions, it may have a side-effect of heavier periods.
• Blood clotting disorders are rare causes of heavy bleeding. Other symptoms are also likely to develop such as easy bruising or bleeding from other parts of the body.

Q: What tests are done at the hospital?

• Ultrasound scan of the uterus. The probe of the scanner may be placed on your abdomen to scan the uterus or a small probe is placed inside the vagina to scan the uterus from this angle. An ultrasound scan can usually detect fibroids, polyps or other changes in the structure of the uterus.
• Endometrial sampling. This is where a thin tube is passed into the uterus. Gentle suction is used to obtain small samples (biopsies) of the uterine lining (endometrium). This can often be done in the gynaecology clinic. The samples are looked at under the microscope for abnormalities.
• Hysteroscopy. This is where a doctor can look inside the uterus. This is done by passing a thin 'telescope' into the uterus through the cervix via the vagina. This is either done under local or general anaesthetic. Small samples can also be taken during this test.

Q: How is heavy menstrual bleeding treated?

Following on from simple symptomatic treatments for heavy menstrual bleeding, you may be offered one of the following treatment options.

• Endometrial Ablation/Resection. An operation where the lining of the womb is surgically removed. It is usually carried out as a day case procedure (going home on the same day as the operation) and the recovery period is usually only a few days. About 90% of women are happy with the results of the operation as they either have no periods or very light periods. The operation fails to improve 10% of women's bleeding and usually does not help with painful periods.
• Hysterectomy - is the traditional operation. It is major surgery. There are many types of hysterectomy. It is 100% effective at curing heavy periods.

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