Some women with heavy periods have a condition such as fibroids or endometriosis that accounts for these. In others, no visible cause is found, but the impact on your wellbeing can be just as severe. My approach is to carry out investigations to rule out any obvious cause and then work with you to decide on a treatment option that suits your needs.
The investigations that may help find a cause for heavy periods include blood tests to check for bleeding disorders, hormone levels and ultrasound scan. In some women a hysteroscopy may be advised; this involves passing a telescope through the neck of the womb into the womb and allows the lining of the womb to be examined. Most women are able to have this in the outpatient clinic without any special pain relief, but it can also be done under anaesthetic if required. If you are having a hysteroscopy, it is important to ensure that you are not pregnant at the time by not having unprotected sexual intercourse in that menstrual cycle.
Your treatment options include non-hormonal and hormonal medicines and surgery. The choice of treatment depends on your medical history, whether or not you need contraception and whether or not you are trying to conceive. The advantage of non-hormonal treatments is that they can be used by women who are trying to have a baby, whereas the hormonal medications are contraceptive (for instance, the contraceptive pill and Mirena coil).
Surgery should be considered where your family is complete and we are unable to manage your period with medications and the Mirena coil. In the past, the only real option used to be a hysterectomy. This is still used by some women, but increasingly i find that women who have completed their family opt to have Endometrial Ablation - a procedure in which the lining of the womb is destroyed using Radio Frequency energy. This causes the periods to either stop or become much lighter. The procedure is done under a short anaesthetic and you can go home the same day. No cuts are needed on the tummy. Of course, once the lining of the womb is destroyed, pregnancy should not be attempted and some form of long-term contraception must be followed after an ablation. One option for this is a laparoscopic sterilisation, which can be done at the same time as the ablation. I offer Novasure Endometrial Ablation. You can read more about it here http://www.novasure.com/uk/