Abnormal Menstruation

A pelvic examination will assess abnormalities within the cervix, uterus (whether enlarged) or ovarian cysts. Inspection of the cervix will indicate whether there is an obvious abnormality, and a cervical/PAP smear will be taken to check for any abnormal cells of HPV infection, unless this has been recently performed.· Ultrasound scan - can show in more detail whether there are any abnormalities within the endometrium (uterine lining) such as polyps or abnormal thickening, within the uterine walls such as fibroids, or uterine endometriosis called adenomyosis. An ultrasound scan will also evaluate whether there are cysts or evidence of endometriosis within the ovaries or fallopian tubes. · Blood tests will indicate whether there is an abnormal hormone profile suggestive of poor follicular development and anovulation, abnormal pituitary hormones and abnormal thyroid all of which can contribute to disturbance of the pituitary ovarian link driving normal ovulation and hormone production.· A hysteroscopy, either outpatient or inpatient, is an examination of the cavity of the uterus via a camera to check for any polyps or abnormalities. A biopsy may well be taken, or the lining of the uterus cleared and sent for histology/pathology to ensure there are no abnormalities. · A laparoscopy is an examination of the pelvis via a camera to exclude cysts or endometriosis within the ovaries, infection and adenomyosis or fibroids within the uterine body itself. Occasionally, endometriosis can be seen scattered over the surplus of the peritoneal cavity which may not be seen on ultrasound scan. 

‘Switching off’ the cycle with hormonal products such as the combined contraceptive pill (containing synthetic oestrogen to effectively switch off ovulation completely.) The mini pill -progesterone only pills - work by suppressing the cycle partially but are not as effective as the synthetic oestrogen containing pill. · Progesterone intrauterine system – IUS. This targets the lining of the uterus directly, switching off the bleeding and can also have a suppressant effect on the ovulatory cycle. Bleeding can be irregular for a few weeks or months after initial insertion with the progesterone coil, but this usually settles quite quickly, and suppression of the bleeds can be maintained for up to five years with this method. This also acts effectively as a contraceptive. · Laparoscopic/ Hysteroscopic treatment of uterine bleeding - If there is thickening of the endometrium or if the endometrial blood vessels are extremely thin, fragile or haemorrhagic, then the patient may benefit from a simultaneous hysteroscopy to check for pathology and take a biopsy and at the same time the uterus can be completely cleared. Sometimes this will be enough to reduce the irregularity and heaviness of the bleeding, particularly if there were polyps within the uterine cavity. · 

 In patients that have completed their family, they may opt for an endometrial ablation. This is best described as clearance of the whole uterine cavity followed by ablation or cautery to the lining cells of the uterus to stop it from growing back. This means that instead of monthly or alternatively unpredictable menstrual cycle which can disrupt day to day living, theoretically the bleeding should gradually resolve, and the front and back walls of the uterus often become attached due to the inflammation of the procedure.·

Heavy bleeding can arise as a result of ovarian cysts, and these can be removed laparoscopically with preservation of the remaining ovary or removal of the ovary and fallopian tube if it appears to be completely diseased and/or if the patient is over 50 years of age. This is always discussed very carefully to ensure that any patients wishing to have a future pregnancy will ensure that maximum ovarian oocytes are retained.