Dr. Neena Singh Kumar
Gynecologic Endoscopic Surgeon

Excessive menstrual bleeding. You do not have to live with it any more!

I bleed very heavily every month, I can not leave home. Is this normal?

Heavy bleeding is not normal, but it is a common problem. One out of every 5 women has unusually heavy bleeding also called menorrhagia.

Women have described symptoms of unmanageable bleeding, flooding, clotting and a constant need to change pads or tampons which quickly become soaked. They feel tired, worry about an embarrassing accident and are frustrated when their period rules their life.

If you have this problem, contact your doctor, because today, you have laser surgery and microwave, heat and freezing techniques to remove the uterine lining and relieve you of these symptoms without any difficulty.

What causes menorrhagia?

The most common cause is hormonal imbalance, especially in women of 35-45 years, just prior to menopause. Benign (non-cancerous) uterine growths, such as fibroids or polypi, infection or chronic illness can also cause excessive bleeding.

How is excessive bleeding evaluated?

In order to find the cause of bleeding and determine the right treatment for you, your doctor will take your thorough history and also may perform tests which provide information about the lining of your uterus talk to your doctor about which tests are appropriate for your specific needs.

Can any drug help?

Drug therapy (such as low dose birth control pills or hormones) is frequently prescribed for excessive bleeding caused by hormonal imbalance. It is often used among women who wish to retain fertility. This can be effective in decreasing bleeding without the need for surgery.

Repeated, long-term treatment is usually required. Minor side-effects are common and may include headache, breast tenderness and weight gain. Major complications are rare.

What if drugs fail?

Dilatation and curettage/hysteroscopic directed biopsy.
If drugs therapy fails, then hysteroscopic directed biopsy under vision is typically the first surgical step. A hysteroscope is a telescope to visualize the interior of the uterus. It is preferred over a blind dilatation and curettage (D&C) nowadays because one can see the inside of the uterus, talk directed biopsies and anything like a polyp (small overgrowth) can be seen and removed and the defect can be corrected.

If D&C fails, is it essential to undergo major surgery like hysterectomy?

No! hysteroscopic endometrial ablation is an acceptable alternative to hysterectomy. A significant reduction of the hysterectomy rate for dysfunctional uterine bleeding would be achieved if an ablation was used as first-time surgical treatment.

Hysteroscopic endometrial ablation destroys and removes the uterine lining with an electrosurgical instrument or laser. The procedure may be performed under general or regional anesthesia. It involves an instrument used to view the uterus (hysteroscope) and a heat source which is inserted through the hysteroscope into the uterus.

The procedure is typically performed in 30-40 minutes. Most women return to work in 2 to 3 days.

This method will reduce heavy bleeding approximately 85% of the time, with light and normal reduction in some patients and elimination of bleeding in others.

Attempts are being made to improve the success rates by refining the technique and endometrial ablation by microwave, heat and freezing techniques are all being evaluated.

What if I have to get a hysterectomy done?

Hysterectomy (removal of the uterus) provides a cure for excessive bleeding. It is a major surgery, which is usually, performed under general anesthesia. Several days have to be spent in the hospital and up to 6 weeks’ recovery is most common.

Laparoscopic hysterectomy has reduced the patients’ stay and recovery time is quick as no big incisions are made. It is also cost effective.