A hysteroscopy is a procedure used to examine the inside of the womb (uterus). It is carried out using a hysteroscope, which is a narrow telescope with a light and camera at the end. It is passed into the womb through the vagina and cervix (entrance to the womb). This procedure helps to see what the problem is, make a diagnosis or even treat the problem.
Heavy Menstrual Bleeding (HMB/heavy periods)
Heavy bleeding during a woman’s menstrual cycle (period) is common and can affect everyday life. In some women heavy bleeding can happen if they have problems such as fibroids or endometriosis.
Most women know how much bleeding is normal for them during their period and can tell when this changes. A good indication that your periods are heavy is if they last longer than seven days and you are:
- Having to change your sanitary products every hour or two hours
- Passing blood clots larger than 2.5cm (about the size of a 10p coin)
- Bleeding through to your clothes or bedding
- Using two types of sanitary product together – for example, tampons and pads.
Usually there is no reason for heavy bleeding during a period. However, there are some conditions which can cause heavy bleeding:
- Endometriosis is a condition that occurs when the lining (endometrium) of the womb (uterus) grows outside of the womb such as the fallopian tubes, ovaries or along the pelvis. Some women with this condition may experience extremely heavy periods with or without clots in their period blood. It can also cause painful periods.
- Endometrial polyps are non-cancerous growths in the lining of the womb or cervix.
Polycystic ovary syndrome (PCOS)
Polycystic ovary syndrome affects how the ovaries work. The ovaries may become enlarged and contain many fluid-filled sacs (follicles) that surround the eggs. These follicles are underdeveloped sacs and are often unable to release an egg (ovulation). This can cause irregular periods and periods can be heavy when they start again.
Fibroids are non-cancerous growths made up of muscle and tough tissue that develop in or around the womb and can vary in size. Other reasons may include:
- An infection in the womb, fallopian tubes or ovaries
- Womb cancer – the most common symptom is abnormal bleeding, especially after menopause
- Blood clotting disorders
Some medical treatments can also sometimes cause heavy periods:
- The coil – a contraceptive device which can make periods heavier for the first 3 to 6 months
- Medication to prevent blood clots
- Some chemotherapy medicines • herbal supplements such as ginseng, ginkgo and soya can affect hormones and periods.
Hysteroscopy for heavy menstrual bleeding is a restricted procedure. The patient’s local NHS commissioning organisation (CCG), who is responsible for purchasing healthcare on behalf of the population, will only pay for the treatment if the patient has one of the following:
- Suspected fibroids, polyps or endometrial symptoms inside the womb and continual bleeding between periods or irregular bleeding
- irregular heavy bleeding and is obese or has polycystic ovary syndrome OR • women taking tamoxifen (type of hormone (endocrine) therapy used to treat breast cancer)
- Heavy menstrual bleeding after having treatment and it has not worked
- Has an ultrasound which did not show clear results.
This means the patient’s NHS commissioning organisation (CCG), who is responsible for buying healthcare services on behalf of patients, will only fund the treatment if an Individual Funding Request (IFR) application has shown exceptional clinical need and the CCG supports this.
Advice and further guidance:
- Read the evidence review
- For more information search ‘heavy period’ at www.nhs.uk
- Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.
Treatment policy for patients covered by NHS Birmingham and Solihull CCG