It is a common condition, each year about one in five women aged between 35 and 49 years old, consult their GP with heavy bleeding. Of all patients referred to a Gynaecologist, a third will have heavy periods.

A period occurs when the lining of the uterus is shed every month. This lining, called the endometrium, always leaves behind a layer of cells from which a new lining will grow after each period. In roughly half the cases there is no obvious explanation for periods becoming heavier. In other cases there may be an abnormality of the uterus or there may be a hormone problem.

A heavy period to one woman might be a moderate period to another. It is difficult to define what is a normal or abnormal period but if your periods are affecting your life you should consult your doctor.

Your GP will need to find out how long your periods last, the length of time you bleed excessively and the number of days between periods. A pelvic examination may be carried out and a blood count may be taken to check for anaemia. The GP will then suggest a course of action for you.

Heavy periods can be treated medically or surgically. Medical options include hormonal or non-hormonal treatment to reduce the menstrual blood loss.

Surgical options include hysterectomy or endometrial ablation. Hysterectomy is the removal of the womb and is a major operation requiring a general anaesthetic. A hysterectomy may require up to a week in hospital and it may be 6 weeks before full recovery.

Dr Farnsworth may ask you to consider a partial or Subtotal Hysterectomy where only the fibroids or part of the womb are removed.

In endometrial ablation, a variety of techniques are used to destroy the lining of the womb, a much smaller procedure, which can be carried out either under local anaesthesia or 'daycase'. One highly effective form of endometrial ablation is Microwave Endometrial Ablation (MEA).

What is Microwave Endometrial Ablation (MEA)?

MEA is a proven treatment for heavy periods which can only be performed by a Specialist Gynaecologist. It is a minimal access surgical treatment which involves treating the endometrium.

Dr Farnsworth must rule out other possible causes of heavy periods. Fibroids or polyps may be the cause of, or add to, your heavy bleeding. MEA can be used in many cases where fibroids or polyps are present without the need for them to be treated separately.

MEA is not a treatment for uterine cancer or endometriosis.

If you still want to have children, MEA, or any other endometrial ablation procedure, is not an option because most or all of the uterine lining is removed and will not grow again.

How does MEA work?

MEA uses high frequency microwave energy to cause rapid but shallow heating of the endometrium (the inner lining of the womb). The heating destroys the endometrium. Many patients have already been treated and clinical trials have reported a satisfactory outcome for nearly 90% of patients with menstrual bleeding stopping completely or being significantly reduced. About 70% of patients treated with MEA also find that period pain disappears completely or is far less intense than before treatment.

The type of microwaves have been specially selected so that the depth of tissue destruction cannot exceed 6mm. The microwaves are delivered by means of an applicator that is gently inserted into the uterus via the cervix. When the applicator is inside the uterus, the microwaves are applied while the applicator is slowly withdrawn with a sweeping movement to ensure that all of the endometrium is treated . A link to a control unit enables the Gynaecologist to monitor and control the treatment temperature.

The microwave treatment takes 5-10 minutes to complete and can be carried out under general or local anaesthetic.

About an hour before therapy, the anaesthetist may give you medication, which minimises cramping during and after the procedure. You may also be given a mild sedative to help you relax. In most cases, you will not be awake during the procedure. Dr Farnsworth may use a local anaesthetic to numb the cervix and the uterus.

You may feel mild cramping like a menstrual period, and you will be given mild medication if it is needed. After treatment you may have a watery healing discharge that can last a couple of weeks, but generally patients do not suffer any postoperative discomfort. You are allowed to go home the same day but 2 or 4 days convalescence is advised.

Drug therapy (such as low dose birth control pill or other hormones) is frequently prescribed. It is often used among women who wish to retain fertility. Repeated long term dosing is usually required and in some cases may provide only temporary or intermittent relief. Side effects are common and may include headache, breast tenderness and weight gain. Major complications are rare.

Dilation and curettage (D&C) is sometimes the first surgical step if drug therapy fails. The top layer of the uterine lining is scraped away which may reduce bleeding, usually for only a few cycles. D&C is usually performed in an outpatient setting under general anaesthesia. Its effect is short term.

Hysteroscopic endometrial ablation destroys and removes the uterine lining with an electrosurgical instrument or laser. The procedure is performed under general anaesthesia, and involves an instrument used to view the inside of the uterus (hysteroscope), and a heat source or cutting device, which is inserted through the hysteroscope into the uterus. The procedure is typically performed in 30-60 minutes. This method may reduce heavy bleeding with light or normal reduction in some patients and elimination of bleeding in others.

Yes, but pregnancies after an ablation can be dangerous for both foetus and mother. This treatment should not be used if your family is not complete - in fact, since there is a chance pregnancy could occur, contraception or sterilisation should be used after treatment. Please discuss these options with Dr Farnsworth.

Don't be afraid to ask questions. Consider taking someone with you to consultations to help you keep track of the facts and think carefully about your options. If you are unsure about your diagnosis and the treatment prescribed do not be afraid to ask for clarification.

Complications are rare, but it must be understood and accepted that these can occur. These may include but are not limited to the following:

a) Infection - there may be a simple infection requiring antibiotics alone. However, a pelvic abscess could develop requiring drainage.

b) Haemorrhage - may be associated with damage to large vessels in the uterine wall..

c) Pain - unlikely to be significant in this day surgery procedure.

d) Uterine damage and perforation. This could result in damage to surrounding tissues e.g., Injury to Bladder or bowel.

e) Fistula Formation - this is extremely rare.

f) Deep Venous Thrombosis - a possible complication of any surgery, but much less likely with this type of operation where you are mobilized almost immediately.

g) Anaesthetic complication - can occur with any operation but the chance is extremely low.

Read what Dr Farnsworth's patients have said about MEA Treatment

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 Dr Bruce Farnsworth © 2007