Menorrhagia is also known as: Heavy Menstrual Bleeding (HMB) or Abnormal Uterine Bleeding (AUB)
HMB or AUB is prolonged heavy menstrual bleeding in regular intervals with total blood loss exceeding
80 mL per cycle or menstruation lasting longer than 7 days.
Uterine bleeding is defined and characterized by:
|Duration of Flow||4-6 days||More than 2 days or Less than 7 days|
|Volume||30 – 60 mL||>80 mL|
|Length of Cycle||24 – 35 days (Average, 28 days)||Greater than 24 days
Less than 35 days
Symptoms of Heavy Bleeding
- Soaking through sanitary pads or tampons every hour
- Fatigue, weakness, headaches, cramping
- Low iron or anemia
- Decreased performance at work
- Inability to focus / depression
- Lack of confidence or nervousness in social situations
Potential Causes: Structural and Non Structural Symptoms
Women can experience heavy menstrual bleeding for a number of reasons, some of which are unknown. Common or potential causes can be broken into two categories:
Usually benign (non-cancerous) structural abnormalities within the uterine cavity or the uterine walls, ie. Polyps and fibroids
- Localized overgrowths of the endometrium (lining of the uterus) that project into the uterine cavity
- As polyps increase in size, heavier uterine bleeding may occur
Fibromuscular growths, also known as myomas or leiomyoma, can be found:
- Within the uterine cavity (submucosal)
- Within the walls of the uterus (intramural)
- Outside the uterine wall (subserosal)
Symptoms of polyps and fibroids
- Irregular bleeding
- Menorrhagia; heavy menstrual bleeding
- Dysmenorrhea; pain during menstruation
Heavy menstrual bleeding that is not caused by an anatomical abnormality could be cause by:
- A balance between estrogen and progesterone regulates the buildup of the endometrium.
- When a hormone imbalance occurs, the endometrium grows in excess and eventually sheds during menstruation
Inherited bleeding disorders
- A person with a bleeding disorder lacks coagulation factor(s) or platelets necessary for coagulation, or ‘clotting’.
- A person with a blood disorder bleeds heavier and longer than others
Medication can be taken to prevent prolonged bleeding, such as: clot promoters (transexamic acid) and hormone manipulators (Gonadotropin releasing hormone agonists, GnRH-a)
Other common hormones include:
- Progestins (Progesterone, Dionogest)
- Androgens (Danazolo)
- Oral contraceptives
Hormonal Intrauterine Systems/Device (IUD)
A hormonal IUD releases a hormone (e.g. levonorgestrel, LNG-IUS) which thins the lining of the uterus and reduces/eliminates menstrual blood loss
Mood swings, headaches, breakthrough bleeding and sore breasts are common hormonal side effects of hormones and hormonal IUD’s
Minimally Invasive Surgery
Dilation and Curettage (D&C)
The process of dilating the cervix and gently manually thinning the endometrium
This procedure may provide temporary relief of heavy periods, but may need to occur more than once if heavy bleeding persists
Myomectomy and polypectomy
The surgical removal of polyps and/or fibroids to relieve heavy bleeding associated with this condition
Endometrial Ablation (EA)
Endometrial ablation is the surgical destruction or removal of the endometrial layer of the uterus. It is only suitable for women with heavy bleeding for benign reasons, who have completed childbearing
Hysteroscopic endometrial ablation can be carried out only by skilled surgeons under direct visualization and usually requires general anaesthesia
Non-hysteroscopic” or Global Endometrial Ablation (GEA) techniques are less invasive and were designed for use under local anaesthesia. Thermablate is a GEA system.
Endometrial ablation is less invasive than hysterectomy and is associated with fewer complications and a shorter recovery time. Women are typically able to return to normal activity within a few days.
A major surgical procedure that removes the uterus entirely. It is performed in a hospital under general anaesthesia and may require a recovery period of up to 6 weeks.
Be sure to discuss the above treatment options with your doctor in order
to fully understand which method is best for you
Thermablate EAS is a clinically proven, gentle, two minute treatment that can significantly reduce or stop the flow of your heavy menstrual period.
How does it work?
- A heat shielded catheter is inserted into the uterine cavity
- At the tip of this catheter, there is a soft tipped silicone balloon
- A heated sterile liquid flows through the catheter and into the balloon
- The balloon conforms to the shape of the cavity, thus gently touching the lining of the uterus
- The balloon inflates and deflates 3 times during the 2 minute procedure
- Through this emission of heat, the endometrium is destroyed
Your doctor will assess several factors in order to determine if Thermablate is the right treatment option for you and your heavy period.
- Prior to treatment, diagnostic testing will be done to determine the size, shape and position of your uterus
- Most importantly, you must be certain that you do not want any children after undergoing a treatment with Thermablate. Your doctor will want to discuss the importance of using birth control post-ablation, and which option is best for you and your lifestyle
- A patient may undergo further testing to rule out pregnancy, uterine cancer or any other underlying issues which may be contributing to your heavy bleeding
Your doctor will help you understand potential risks associated with the procedure as well as the likelihood of mild side effects such as cramping, nausea and vomiting, spotting and/or discharge post procedure.
Many women have learned to accommodate their heavy periods throughout their daily life – but at a high cost. Dealing with the intensity of a heavy period can be expensive, frustrating, and extremely limiting.
The National Women’s Health Resource Center conducted a national survey of 653 women between the ages of 35 and 49 with heavy menstrual bleeding, to examine excessive menstrual bleeding and its negative impact on daily activities (graph below):
National Women’s Health Resource Center. Survey conducted Sept 29-Oct 12, 2005
- 54% report their heavy bleeding has negatively affected their sex lives ‘many times’
- 38% report sometimes skipping social events due to heavy menstruation
- 35% report sometimes veering from athletic activity due to heavy menstruation
- 34% report sometimes neglecting time with family/friends due to heavy menstruation
Your period should not put you and your life on hold
Find out if Thermablate can help
Your physician may prescribe therapy prior to Thermablate treatment to begin the process of thinning the endometrium. He or she may prescribe treatment daily by mouth, or monthly vaginally or by injection.
Prior to treatment, general or local anaesthesia is administered to the patient as Thermablate is safe and suitable in both inpatient and outpatient settings.
Nurses or the physician have already inserted the Thermablate catheter into the Treatment Control Unit and have switched it ON; the heating process takes about 10 minutes.
Prior to treatment, your gynaecologist will take a quick look inside your uterus using a diagnostic hysteroscope; a thin lighted tube with a camera on the tip, to assess the uterine cavity and ensure there are no perforations or abnormalities of any kind.
Once your doctor is ready, he/she will gently insert the balloon tip catheter into the uterine cavity and initiate treatment.
The balloon will inflate and deflate 3 times throughout the 2 minute treatment. Liquid is pumped back and forth through the heat shielded catheter and into the balloon, to ensure temperature consistency.
The balloon lightly touches the walls of the uterus and gently destroys the endometrial layer using thermal energy.
After 2 minutes and 6 seconds, the procedure is complete.Your doctor will use the hysteroscope once more to ensure treatment has been effective.
With a successful Thermablate treatment, a patient may experience these eventual outcomes:
- Reduction in bleeding
- Amenorrhea (no bleeding)
- Hypomenorrhea (minimal bleeding, spotting)
- Eumenorrhea (return to normal period)
Mild pain or cramping
Pain and/or discomfort post ablation are usually minimal and can be similar to menstrual cramps. You may also experience mild nausea and/or vomiting, which can be controlled or quelled with a prescription from your doctor (e.g. Ibuprofen).
- It is likely you will be able to return home a few hours after your procedure
- A mild discharge may also be present for a few days post ablation
- Avoid using tampons or engaging in sexual intercourse while you are experiencing discharge post procedure, to ensure your body is fully healed
The majority of women experience positive changes in their life after a Thermablate procedure:
Freedom to live a normal life • Financial benefits • Better health • Increased energy
Mayo Clinic. Diseases and Conditions: Menorrhagia (heavy menstrual bleeding) www.mayoclinic.org/diseases-conditions/menorrhagia/basics/causes/con-20021959. Accessed November 8, 2016..