In not the too distant past hysterectomy used to be the main method of treatment for women who had abnormal heavy menstrual bleeding. Now there are alternatives and these should be explored before the decision to have a hysterectomy is made.
For young women who have not completed their families and in whom all investigations have returned as normal. The treatment will depend on whether fertility is an immediate issue or not.
The treatment for women who want to get pregnant immediately is Tranexamic acid and or Mefenamic acid.
Tranexamic Acid can reduce the menstrual flow by up to 30%. It can also be used in women who have small fibroids that are outside the cavity of the womb.
Mefenamic Acid is a painkiller (non-steroidal anti-inflammatory agent) and is particularly useful in women with painful periods. Because of the way it acts it can also reduce menstrual flow by 20-30%.
For women with heavy painful periods it is not unusual for these medications to be prescribed together. They are used from the first day of bleeding until the bleeding stops, for every cycle.
They do not stop women from getting pregnant and have no adverse effect on pregnancy.
For women who do not want to get pregnant immediately the commonest method of treatment is the oral contraceptive pill. Apart from being an effective method of contraception the “pill” is effective in reducing menstrual flow and reducing pain during the menstrual cycle. They can also be particularly useful in women who have irregular cycles as with polycystic ovaries. It is also advised in women who have painful periods as in endometriosis.
It may take a while for the pill to work. It is important that a comprehensive history is taken and physical examination is carried out before starting the pill. To make sure that the right pill is prescribed and possible side-effects taken into consideration.
For women who are not able to take the combined oral contraceptive pill (containing oestrogen and progesterone), a pill containing only progesterone may be advised.
For some women where contraception is not an immediate issue who suffer from heavy irregular periods hormonal preparations known as progestagens may be advised. Examples of these are Norethisterone and Provera. These medications can be taken cyclically or on occasion from day 16-25 of the cycle. for the majority of women these medications will have no side effects. however they can cause nausea, acne and most importantly changes in mood. if this happens stop taking the medication and consult your doctor.