02 March 2007

Dealing with heavy periods

For most women, the average loss of blood during a menstrual period is a little more than 30 millilitres.

For most women, the average loss of blood during a menstrual period is a little more than 30 millilitres.

But an estimated 2 million South African women lose much more because they suffer from a condition called menorrhagia. And most don't realise there are treatments that can help ease the problem.

Traditionally, a hysterectomy - removal of the uterus - has been the only option available to doctors to treat the condition. But in recent years, researchers have pioneered alternatives so the heavy bleeding can often be eliminated or greatly reduced without radical surgery.

Much more than just an annoying period
Dr Philip Brooks, a Los Angeles gynaecologist and clinical professor at UCLA's David Geffen School of Medicine, says menorrhagia is much more than just an annoying period.

The condition can be disabling, causing women great difficulty working or doing other daily activities because the flow is so great. "They wear towels, not menstrual pads," Brooks says.

About 600 000 hysterectomies are performed each year in the United States, according to the US Centers for Disease Control and Prevention, and about one-fifth are done to treat menorrhagia, health experts say.

Less drastic measures employed
But in recent years, Brooks and other physicians have turned to less drastic measures. They include various types of ablation, procedures in which the lining of the uterus - called the endometrium - is destroyed to control the excessive bleeding.

Even before ablation is recommended, however, there are other steps that can be considered, says Dr William Parker, a gynaecologist at Santa Monica-UCLA Medical Center in California. He often uses a hysteroscope, a tiny telescope-like device, to do a visual inspection of the uterine cavity.

Reasons for bleeding
"We look to see if there are any fibroids, polyps and lesions," he says, adding the early stages of pregnancy can also lead to heavy bleeding.

Many women with menorrhagia are in the 40- to 50-year-old age bracket, and lack of ovulation during cycles is a main reason for the bleeding.

If a follow-up test - such as an ultrasound - of the uterine lining shows it's normal, Parker might prescribe low-dose birth control pills or other medication to slow the excess bleeding.

If medical treatments fail after three months or so, Parker says he offers the option of ablation.

Four methods of ablation
The US Food and Drug Administration has approved four methods of ablation in recent years, says Brooks, who lectured on the topic at the recent annual meeting of the American College of Obstetricians and Gynecologists.

Earlier techniques required a doctor to have specialised training. However, the newer treatments are easier for doctors to master, Brooks and Parker agree.

One of the newest, called hydrothermablation, is done on an outpatient basis, and involves the insertion of a hysteroscope to view the cavity during the procedure. A hot saline solution is delivered into the uterus through a tube inserted into the cervix. The water destroys the lining of the uterus, or most of it, in 10 minutes or so. The type of local anaesthesia and other pain relief used varies, depending on the woman.

How ablation works
Ablation "destroys the blood vessels and endometrial glands that build up and shed," Brooks says. Basically, it destroys the uterine lining enough to solve the bleeding problem but sometimes not enough to stop periods.

He says about 50 percent of women who undergo ablation no longer have periods; the other 50 percent continue to have periods, but they are much lighter.

The results of hydrothermablation are very effective. "We have a 94 percent success rate - either no period or scant periods," says Brooks, who teaches courses to train other doctors in the technique.

Women who have ablation should have completed their childbearing because the uterine lining is no longer capable of sustaining a pregnancy, doctors say. But because most women affected by menorrhagia are nearing the end of their reproductive years, motherhood isn't usually a concern.

Some women still opt for hysterectomies
Yet even with the high success rates of ablation techniques, says Parker, some women say to him, "I don't want a 10 percent risk." And they opt instead for a hysterectomy.

While a traditional hysterectomy requires about four to six weeks recovery time, ablation is usually a day or so, Parker says. – (HealthScout News)

Read more:
A-Z of menorrhagia
Menopause Condition Centre
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