Gynaecological Treatments

There are several methods that we can use to help with treating heavy periods. Some of the more common ones are listed below.

Non-steroidal inflammatory medication – This group of medications includes Ibuprofen, Naproxen and Ponstan which can be helpful reducing the volume of the period and reducing cramps, however they do have some side effects. This can include nausea, diarrhoea and headache.

The oral contraceptive – The oral contraceptive works by thinning the lining of the uterus and is generally effective in controlling periods. There are however a number of potential side effects which are important to go through and we can talk about this in your consultation.

Progesterone – This medication can be administered but we tend to use it less often because it has been known to cause bloating, irregular bleeding and mood swings in some patients.

Tranexamic acid – Tranexamic acid works by causing clotting in the blood vessels lining the uterus. It is normally only taken on the days when bleeding is heavy. Side effects can include diarrhoea and nausea.

The Mirena coil – This is a really effective way to treat heavy periods. If you have had normal births in the past we can insert this coil in the examination room at my practice. If you haven’t had any vaginal births before we may need to dilate the cervix, in which case the coil can be inserted in hospital under an anaesthetic. Mirena works by releasing the hormones locally and by thinning the lining of the uterus. There are a number of potential side effects and complications associated with this IUD which are important to go through and we can talk about this in your consultation.

An endometrial ablation procedure can be done a number of ways and is used to treat prolonged, heavy bleeding. It does not involve any surgical incisions and I insert a small telescope in through the neck of the uterus. The ablation thins the lining of the uterus and is very effective. Complications are uncommon with a risk of 1 in 500 of a perforation. The technique I currently favour is a radio frequency ultrasound ablation. There are a number of other techniques including Thermachoice and Cavaterm.

A hysteroscopy is an investigative procedure that we perform in hospital, where a small telescope is inserted inside the uterus to diagnose and treat heavy periods.

A hysterectomy is a procedure that involves removing the uterus. It can mean removing the body of the uterus with or without the cervix. There are different ways we can perform this operation which are listed

Total hysterectomy
A total hysterectomy involves the removal of the body of the uterus and the cervix (neck of the uterus) however the fallopian tubes and ovaries are not removed. In a sub total hysterectomy the body of the uterus is removed but the lower part of the uterus (the cervix) remains.

Total hysterectomy and bilateral salpingo oophorectomy
In this operation the body of the uterus (the cervix) both ovaries and tubes are removed.
The technique of removal varies and it depends on the route by which the operation is performed.

Total laparoscopic hysterectomy
A total laparoscopic hysterectomy involves the removal of the uterus through a small telescope. You can go home a couple of days after the operation but we do advise avoiding exercise, heavy lifting or sex for about six weeks after this operation.

Laparoscopic assisted vaginal hysterectomy
The laparoscope is used to perform much of this surgery and the lower part of the uterus is removed through the vagina. Patients with a prolapse are ideally suited to this sort of procedure and discharge from hospital occurs 2 to 3 days following the operation. A pack is usually inserted into the vagina after the operation and is normally removed the day after surgery.

Vaginal hysterectomy
In this procedure, the uterus is removed through the vagina and the surgery is carried out through the vagina. This is a good way of fixing any prolapse which may also be present. There is a vagina pack inserted at the end of the operation which is removed the next day. This normally allows for a quick recovery.

Total abdominal hysterectomy
This operation involves the removal of the uterus through a side to side (transverse) or bikini incision. Rarely, a vertical (up and down) incision might be required. You are in hospital for longer (usually five days) and recovery is slower than with laparoscopic or vaginal hysterectomy.

Surgery complications
All surgery carries a risk of complications. Bleeding or infection as well as clots (DVT) in the legs and clots going to your lungs (pulmonary embolus) are some of the more serious ones. Injury to bowel, bladder, ureter (the tube that joins the kidney to the bladder) can sometimes occur. Painful or unsightly scars are very uncommon. Long term problems may occur, such as adhesions between bowel and the top of the vagina which can produce pain or bowel obstruction. Fortunately this sort of complication is not common. It is most important that if you have any concerns after surgery that you contact me.