Control your period
Larger polyps in the uterus, fibroids or cancers and their precursors can cause heavy bleeding and should be excluded. Much more often, however, the trigger is found in the hormonal system of the affected women. Especially at the beginning and towards the end of the reproductive phase, bleeding disorders with heavy or prolonged bleeding are not uncommon. They are caused by oestrogen dominance, which in young girls can be attributed to the not yet fully developed hormonal axis, and in menopausal women to the declining ovarian function. Oral contraceptives have proven effective for treatment. If there are contraindications or the desire for long-term contraception, a hormonal IUD (levonorgestrel intrauterine system) can be used. It can reduce the intensity of bleeding by up to 90 per cent.
If hormonal therapy is not successful or cannot be carried out, the doctor may consider surgical treatment. Unlike in the past, however, the focus is no longer on removing the uterus (hysterectomy), but on sclerosing or removing the lining of the uterus (endometrial ablation). The aim is to stop the monthly build-up and breakdown of the mucous membrane as far as possible. Thirty to 40 per cent of the women treated in this way are permanently free of bleeding after the procedure; in the other part, the mucous membrane still functions, but to a limited extent. These women continue to have periods, but usually only very lightly. In about 5 percent of the women, the therapy fails completely, the bleeding intensity does not change.
The most important prerequisite for endometrial ablation is completed family planning, because the procedure is irreversible. Conversely, however, endometrial sclerotherapy is not a reliable contraceptive method. Pregnancies are rare, but theoretically possible and are associated with an increased risk of malformation in the children.
Endometrial ablation is performed hysteroscopically, i.e. by means of a uterine endoscopy. In the classic procedure, doctors work with a so-called resectoscope, which enables the removal and obliteration of the endometrium with various instruments under permanent visual control. If the doctors find any fibroids or polyps during the operation, they can be removed directly. The entire procedure takes about 15 to 30 minutes.
In addition to the classic procedure, there are newer methods that work with other techniques. In Germany, the so-called uterine balloon therapy (Thermachoice®) and the gold net method (NovaSure®) are currently offered. One disadvantage of the newer methods is that they are not covered by statutory health insurance. Some surgical centres and hospitals do have contractual agreements that allow reimbursement by the health insurance fund, but not all of them and not with all health insurance funds. It is advisable to obtain information about the costs in advance.
Regardless of the procedure used, endometrial ablation is considered a much gentler alternative to hysterectomy. It allows the organ to be preserved and protects the pelvic floor. Although the procedure is performed under general anaesthesia, it can be done on an outpatient basis or during a short inpatient stay of maximum three days. Wound pain after the procedure is considered very mild and is compared to menstrual-like discomfort. Most women can return to all normal physical activities after two to three days. A return to work is possible after one week at the latest. A brownish discharge may persist for about two to three weeks. During this time, the woman should avoid baths, swimming pools and saunas, tampons and sexual intercourse.
The success rate of endometrial ablation is also considered very good. Several years of follow-up have shown that in 70 to 80 percent of women treated classically, the bleeding intensity could be successfully and permanently reduced. The risk of mucous membrane regrowth and renewed bleeding disorders is about 20 to 30 per cent. The newer procedures achieve even better values. Here, the success rate is over 90 per cent. In addition, the procedure is considered to have few complications. Perforation of the uterine wall or injury to neighbouring organs is very rare. In individual cases, adhesions can remain on the uterine walls, in which there are still islands of mucous membrane. As these cannot bleed off with the period, a blood congestion occurs, which manifests itself in pulling abdominal pain. Another endometrial ablation is possible, alternatively a hysterectomy can be performed.
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