Medical and surgical treatment options for menorrhagia
If you have heavy or uncomfortable periods, your general practitioner or gynaecologist is the best place to start. They will provide you with information and options for a treatment plan.
In Australia, most women with menorrhagia are presented with two treatment pathways: medication or surgery.
Medication-centred treatment is usually explored first, as it is less invasive and may have fewer side effects than surgical options. Medications are usually also less likely to have implications for your fertility later in life.
Depending on your situation, your doctor may recommend medications including clotting agents to reduce your flow, anti-inflammatory drugs or contraception delivered via a pill or a hormonal-releasing intrauterine device (IUD).
All medications have potential side effects and pros and cons, so don’t hesitate to ask your doctor as many questions as you need to make an informed decision. The Royal Women’s Hospital have a useful overview of the medical treatment options for menorrhagia, including a summary of their pros and cons, on their website.
If medications do not alleviate your symptoms, or don’t work for you for other reasons, surgery may be offered. There are three main types of surgeries recommended for people with heavy periods.
A hysterectomy is the most invasive surgical procedure for menorrhagia and has the longest recovery time. It is usually the last resort, as it eliminates your ability to conceive in the future. It also has greater risks as a major surgery in which the uterus is removed entirely, sometimes along with your cervix, fallopian tubes and ovaries.
In some cases, it can trigger the onset of early menopause. On the plus side, it is the only guaranteed way to stop vaginal bleeding altogether, and it may even stop period pain and reduce the risk of uterine and ovarian cancers.
Myomectomy involves removing any fibroids from your uterus. It is typically effective at reducing heavy bleeding if fibroids are the underlying cause, and is a good option for people who want to have children in the future. However, risks include fibroids regrowing, blood loss and, in emergency situations, the need for a full hysterectomy.
Endometrial ablation is the least invasive and safest surgical option for heavy periods, with most patients spending only one day in hospital. Endometrial ablations involve removing or destroying the lining of the uterus using heat or microwaves. It can be done under general or local anaesthetic.
Endometrial ablation provides significant relief for about 85 per cent of patients who have the procedure, and can also be used to remove fibroids and polyps. The main downsides of this procedure are the risk that heavy bleeding can return, and the fact that future pregnancies will be risky and thus not recommended.
For women not wanting to have children, endometrial ablation is a fast, effective option that doesn’t require a lifetime of medication or invasive surgery. So why are they still relatively rare in Australia?