Also referred to as menorrhagia or dysfunctional uterine bleeding (DUB), heavy menstrual bleeding (HMB) affects 25% of women during their reproductive years (ages 15-45). It is the commonest reason for referral to a gynaecologist.
Normal bleeding averages 40 ml per cycle. HMB is when the loss is over 80 ml. If a woman considers she has HMB she will often describe her symptoms as “I use double protection, I have to take time off work, I flood like a tap, I cannot wear white clothes, and I am drained all the time.”
It affects all aspects of a woman’s quality of life but over 70% of people wait up to a year before seeing a gynaecologist.
HMB may be associated with concurrent benign diseases such as fibroids, endometriosis and pelvic inflammatory disease.
For women over 45 years; the danger or ‘red alert’ features which may mean pelvic cancer include pain, irregular bleeding, intermenstrual bleeding or bleeding after sexual intercourse. A history of PCOS, obesity or a family history of breast, colon or endometrial cancer may be indicators of pelvic cancer. However, do please remember pelvic cancer is rare.
In approx 10% of patients, tests reveal no abnormality and the patient is happily reassured. The rest will need a range of treatment options which include progestogens, NSAIDS, tranexamic acid, antifibrinolytics and the oral contraceptive pill or a combination of these. Many would have already tried complementary treatments such as hypnosis, acupuncture and herbal preparations, which typically will help 50-60% of women.
If the above treatment options fail then the next option is to fit a mirena coil, which will cure 90% of cases. This can produce complete amenorrhoea (absence of menstruation) in 70% of cases. The main reason not to use this effective treatment is if you have not had children or contemplating a family in the near future.
For a woman over 35 years, whose family is complete or indeed does not want children the best surgical treatment is endometrial ablation or resection. Mr Annan personally will not perform a hysterectomy for HMB, although a few women ask for this as a permanent cure.