Should you have a hysterectomy?
The problem: Women who suffer excessively heavy or painful periods - the clinical condition of menorrhagia - often have hysterectomies. Although this stops all bleeding, it can have serious side-effects and less drastic treatments can often solve the problem.
What causes menorrhagia?
Menorrhagia is one of the most common reasons women over 30 see their GP, yet it is little talked about. There is usually no obvious cause - some doctors blame fibroids (growths in the womb) - but it is often very disruptive and distressing.
How is it diagnosed?
That's part of the problem. Measuring bleeding is very subjective. Many women treated for menorrhagia actually have normal blood loss while others with severe problems suffer in silence. Getting information and reassurance is important.
What are the options for treatment?
There are two basic choices: drugs and surgery. It is best to try a course of tablets first.
Which medicines work best?
The most commonly prescribed tablets, norethisterone (a form of progestogen), are the least effective. Trials show tranexamic acid - prescribed rarely - works best, reducing bleeding for more than half of women. Another drug, mefenamic acid, works reasonably well and also alleviates period pains. A progestogen-releasing contraceptive coil has proved very effective in Scandinavia.
What if drugs fail?
Hysterectomy is the most common surgical option. This is completely effective - it stops periods. But the operation has a high rate of complications, recuperation can take three months, and it may trigger early menopause (certainly if the ovaries are also removed). This can mean taking HRT for many years. It also increases the chance of osteoporosis and heart disease. Alternatively, the womb lining can be removed (called endometrial resection or ablation) by laser or a hot metal loop. Although less effective, this has fewer side-effects. Many doctors still commonly perform dilatation and curettage (D&C), where the lining of the womb is scraped away and checked for cancer, to try and cure menorrhagia. But studies show D&Cs have no effect on reducing bleeding, and cancer of the womb lining is so rare in women under 40, that the dangers of surgery far outweigh the benefits. For women over 40, there are newer, safer cancer checks.