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Investigating heavy bleeding There are a number of tests your GP can do to try to find the cause of your heavy bleeding. She or he should take a thorough medical history and give you an internal pelvic examination. You will have a blood test for anaemia and possibly a thyroid function test. If you have not had a cervical smear test in the last three to five years, you should arrange to have one. Women over 40 years may be offered a hysteroscopy or D&C (see surgical procedures section). D&C was the standard way of investigating and treating heavy bleeding, but hysteroscopy and endometrial aspiration are less invasive and more effective. When a cause is found: If the cause of your heavy bleeding is found during these investigations, you will be offered the relevant medical treatment. If you have a contraceptive coil (IUD) fitted, your doctor will probably recommend that it be removed, as this is one cause of heavy bleeding. (see the drug treatment section). Pelvic inflammatory disease is treated with antibiotics and bed rest, polyps usually by hysteroscopic removal, cancer of the lining of the uterus by hysterectomy and/or radio or chemotherapy, and hypothyroidism by hormone replacement therapy. |
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 Fibroids are the most common known cause of heavy bleeding. Fibroids are noncancerous growths made of bundles of muscle fibres that grow in the muscle wall of the uterus. Those that form just under the lining of the uterus are more likely to cause problems because they increase the surface area that is shed every month during a period. Even small fibroids in this position can increase the amount of blood lost. You have several choices if you have fibroids: have no treatment, take tablets (see drug treatment), have a hysterectomy or myomectomy (an operation to remove the fibroid), or have the fibroid embolised (this is where the blood supply to the fibroid is blocked). Your decision will depend on how you feel about your heavy bleeding and how it is affecting you. (For more information see Women's Health Fibroids leaflet). When no cause is found: For more than half of all women with heavy bleeding, no cause is ever found. This is because the complex workings of women's bodies are still not completely understood. Once you have made sure there is nothing medically wrong with you, you may be better able to adapt to your increased menstrual blood loss, and your doctor may also agree that a 'wait and see' policy would be best. If you are already sure that you cannot cope with your increased blood loss, there are two possible courses of action. You may be referred immediately to a gynaecologist, or your doctor may prescribe a course of tablets before referring you, to see if these help control the bleeding. If you are referred to a gynaecologist straight away you may be given an appointment for a D&C and prescribed a course of tablets. Some consultants suggest having an endometrial biopsy which can be done under local anaesthetic. An instrument is passed through your cervix and takes tiny samples of tissue from the lining of your uterus. These can be examined to try and find the cause of the bleeding. Some doctors use an hysteroscope, a viewing instrument which can be passed through the cervix into the uterus, to examine the uterine lining, take samples and perform some procedures, such as TCRE (see surgical procedures). After trying some or all of these, a hysterectomy will probably be considered. A major consideration in your gynaecologist's mind is your age. If you are under 35, and especially if you are still considering childbearing, you are less likely to be offered a hysterectomy. If you are over 40, you are more likely to be offered one. If you are over 45, your gynaecologist may prefer to do nothing because your approaching menopause will eventually cure the problem. |
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All original illustrations © Michelle Forster unless otherwise indicated
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