Questions and answers

Q1 What is excessive menstrual bleeding?

Excessive Menstrual Bleeding (EMB) or Menorrhagia is clinically defined as excessive regular menstrual blood loss of 80ml or more per monthly period. A woman's perception of the amount of menstrual bleeding can often mean that bleeding at a lower rate than the clinical definition is unacceptable to her. 

Q2 How common are heavy periods?

Many women have heavy periods, which interfere with their daily lives. Each year many women aged between 35 and 49 years old, consult their physician with heavy bleeding. 

Q3 What causes 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 many cases there is no obvious explanation for periods becoming heavier. In other cases there may be an abnormality of the uterus, such as fibroids or polyps which contribute to excessive bleeding, or there may be a hormone problem. 

Q4 What should you do if your periods are heavy?

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

Q5 How is it treated?

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 uterus and is a major operation requiring a general anesthetic. A hysterectomy may require up to a week in hospital and it may be 6 weeks before a full recovery. In endometrial ablation, a variety of techniques are used to destroy the lining of the uterus. It is a much smaller procedure, which can be carried out either under local anesthesia and/or as an 'outpatient'. One highly effective form of endometrial ablation is Microwave Endometrial Ablation (MEA). 

Q6 What is Microwave Endometrial Ablation (MEA)?

MEA is a proven treatment for heavy periods, which can only be performed by a Gynecologist. It is a minimal access surgical treatment (i.e. does not involve major surgery), which involves treating the endometrium. MEA is predominately carried out as a day case procedure, which means it does not involve an overnight stay. Normal activity after an MEA can be resumed within 2-4 days. 

Q7 Am I a suitable candidate for MEA?

Your gynecologist 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.

Q8 How does MEA work?

MEA uses high frequency microwave energy to cause rapid but shallow heating of the endometrium (the inner lining of the uterus). The heating destroys the endometrium. Thousands of 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 their period pain disappears completely or is far less intense than before treatment. The type of microwaves has been specially selected so that the depth of tissue destruction cannot exceed 6mm. The microwaves are delivered by means of an applicator, (slightly thicker than a pencil ) which is gently inserted into 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 gynecologist to monitor and control the treatment temperature. The microwave treatment takes about 3 minutes to complete and can be carried out under local anesthetic (patient awake) with light sedation, if needed. However you can still have your MEA treatment under general anaesthetic (patient asleep) if you prefer or if your doctor recommends it. 

Q9 What will I feel during the procedure?

About an hour before therapy, your gynecologist may give you medication, which minimizes cramping during and after the procedure. If you wish you can choose to be awake during the procedure, and your gynecologist may use a cervical block to numb your cervix. You may experience cramping and/or slight discomfort during the 2-3 minutes of treatment. Alternatively you may want to be "put to sleep" using light sedation or general anaesthesia. This is an option for you to discuss with your gynecologist. The MEA treatment is exactly the same whichever type of anaesthetic you have. There are no stitches or scars on the abdomen. 

Q10 What will I feel after the procedure?

You may feel mild cramping like a menstrual period, and your gynecologist will give you 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 post-operative discomfort. You are allowed to go home the same day but 2 to 4 days convalescence is advised. 

Q11 What other treatments are available for me?

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. 
Hysteroscopic endometrial ablation destroys and removes the uterine lining with an electro surgical 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 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. 

Q12 Can I get pregnant after treatment?

Yes, but pregnancies after an ablation can be dangerous for both fetus 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 sterilization should be used after treatment. Please discuss these options with your doctor. 

Q13 How is the uterus measured before the MEA Treatment is performed?

Measurement of the uterine cavity length is a very common procedure for a gynecologist. The uterus is measured with a stainless steel instrument designed for this purpose and the depth is recorded. 

Q14 Can a patient become distressed during treatment if she is only under local anesthetic?

There is always a possibility that a patient can become distressed with any treatment carried out under local anesthetic. With MEA however, the treatment is very simple and quick to administer so it is unlikely that the patient will become distressed