• One in five women would suffer from heavy periods, or menorrhagia.

  • The causes are multiple, but therapeutic solutions allow patients to regain a better quality of life.

  • Among the possible treatments depending on the case, minimally invasive surgeries outside the operating room are developing.

Having to change your towel or tampon constantly, or even having to put on both to avoid a clothing disaster.

Having pains that twist the belly.

And feel exhausted as the bleeding is important.

For women suffering from very heavy periods, or menorrhagia, seeing the English land can turn into a nightmare every month.

However, suffering and Niagara Falls in the panties are not inevitable.

Therapeutic solutions are available to allow them to regain comfort and serenity.

Among them, minimally invasive surgical procedures can be offered to some.

Evaluate its flow and make the diagnosis

When are periods considered heavy?

“Usually, women know if they are losing a lot or a lot of blood,” notes Professor Hervé Fernandez, head of the obstetrics gynecology department at CHU Bicêtre and former president of the Society for Gynecological and Pelvic Surgery.

A tool, the Higham score, makes it possible to objectify this heavy bleeding”.

Among these elements: the number of periodic protections used each day of menstruation and their level of saturation are all indicators.

"Then, we must find the cause of these menorrhagia".

Extreme fatigue, anemia and strong anxiety are also common repercussions of heavy periods, which affect an average of one in five women.

“A clinical examination, an ultrasound or even a hysteroscopy [exploration of the uterus with a small camera] make it possible to make the diagnosis, indicates Dr. Vincent Villefranque, head of the gynecology department at the Simone-Veil hospital in Eaubonne.

The causes can be organic: polyp, fibroid or adenomyosis [a particular form of endometriosis which affects the uterus];

functional, for example in case of polycystic ovary syndrome (PCOS);

or even hormones.

And this is a major subject: abnormal bleeding is the leading cause of consultation for women aged 40 to 50.

Hence the importance of an accurate diagnosis”.

Minimally invasive surgeries for rapid treatment

Once the diagnosis has been made, “depending on the pathology and the pregnancy plans or not, medical or surgical treatment will be offered, adds Professor Fernandez.

But it is proposed in the light of a new paradigm: the notion of a young woman of childbearing age is changing, and patients aged 45, or even 48, may wish to become pregnant.

In which case the proposed therapeutic elements will have to be adapted, and they will not necessarily be eligible for certain minimally invasive surgeries.

A woman wishing to preserve her fertility will be able to benefit from this care in the event of a polyp, for example, but not when her menorrhagia is due to an endometrium that is too thick requiring endometrial destruction,” he warns.

For women eligible for surgery, it is not always easy to consider the intervention.

“When surgery is prescribed, the classic course provides for an intervention in the operating room, under anesthesia, followed by a work stoppage, which can be a little scary, notes Dr. Villefranque.

This is why it has become necessary to develop the path of patients, he insists, to be able to offer them minimally invasive surgeries via rapid treatment in the office, for lesions such as polyps or fibroids.

This is how consultation and exploration units have come into being, where operative hysteroscopies can be offered outside the block.

This allows, in a single procedure, to make a rapid diagnosis and offer the least invasive treatment possible,

for an intervention of just a few minutes, without scalpel or general anesthesia, but with local anesthesia.

This care saves a lot of stress for the patients, who recover much faster.

And with a very high satisfaction rate.”

An evolution favored by a change in nomenclature accompanied by incentive pricing, and by “a context of delay in care at the height of the Covid-19 pandemic and shortage of caregivers, which highlighted the need to mark out effective routes outside the operating theaters,” explains Dr. Villefranque.

Booming surgery

And these off-block minimally invasive surgeries are booming.

They can sometimes also be indicated for patients suffering from functional metrorrhagia, heavy bleeding that can occur outside of menstruation or after menopause, the cause of which can be organic or linked to a hormonal imbalance.

“Previously, the first-line treatment was the insertion of an intrauterine device, a hormonal IUD, reports Dr. Villefranque.

But if overall this treatment works well, in detail, a quarter of patients will not tolerate it and will have bleeding every day for the first three months, which can legitimately discourage some of them”.

But “today, many women are turning away from hormonal treatments, underlines Professor Fernandez.

To date, approximately 90,000 hysteroscopies are performed each year in France.

And “by emphasizing the training of practitioners in this gesture no more complicated than the insertion of an IUD, recalls Dr. Villefranque, in the long term, the majority of them could be carried out outside the operating theaters”.

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