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Abnormal bleeding / Problem periods
By definition
any vaginal bleeding that occurs at the wrong
time is abnormal but women are also often troubled
because the nature of their bleeding has changed
such that it is a different colour or has a different
odour from normal or is much heavier and contains
clots. Some women will complain that their periods
are becoming lighter or have been missed.
Not all of these abnormalities require investigation
and treatment, but some such as any bleeding after
the menopause must be reported to a physician
directly and appropriate investigation instituted.
Basic investigations for period problems include
a detailed history of the presenting complaint
and a physical examination. The Gynaecologist
will usually perform a smear test and in addition,
an ultrasound scan (preferably performed at the
time of your visit). Where appropriate swabs may
be taken to screen for infection and a sample
may be taken from the lining of the womb. Sometimes
it may be necessary to perform a pregnancy test
to ensure that you are not pregnant or blood tests
to check the hormone profile.
Once these results are available your doctor will
be able to advise you whether or not further tests
are required and if necessary to start appropriate
treatment.
D & C and hysteroscopy are the next step in
the investigation pathway. Link to D & C Hysteroscopy.
If no specific abnormality is found you may decide
not to undergo treatment. However, the Oral Contraceptive
Pill (OCP) may be very useful in controlling the
bleeding and regulating the cycle. There are many
types of pill and you may have to try two or three
before you find the right one for you. Other drugs
that are not hormone based such as Tranexamic
acid and Mefenamic acid may also be used to reduce
bleeding if this is the problem. They work by
changing the environment inside the womb so that
you actually bleed less and by helping your blood
to clot more easily. Their great advantage is
that they need only be taken at the time of a
period.
In the past in older women who had completed their
family, bleeding problems often lead to Hysterectomy.
These days, there are newer, less invasive treatment
options which allow successful treatment in the
majority of cases thus reducing this risk of requiring
major surgery. Currently the most popular of these
are the Mirena Intrauterine Contraceptive Device
(Mirena IUS) and Endometrial ablation. Link to
these two proceedures
If a hysterectomy is necessary this is normally
only undertaken after other treatments have failed.
In experienced surgical hands it can usually be
performed through the vagina or using Keyhole
surgery techniques. The great advantage of these
is that the recovery form surgery is much quicker
and the patient may be back to normal within as
little as two weeks. Link to Hysterectomy
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