To ask for a gynaecologist expert opinion please?

[MerciVeryMuch]

Hello.

Posting here for traffic.

Sorry for the long post but I don't want to drip feed. Please bear with me as I am desperate for an answer.

I've been bleeding every single day for almost a month now, with my "periods" getting heavier and heavier culminating in flooding for the past week. Nothing seems to work.

I've always had regular seven days periods but about six/seven months ago, suddenly, out of the blue, I started haemorrhaging and it lasted for about 3 weeks. Since then my periods are very irregular, flooding (much heavier than post-partum bleeding) with at least a month and a half interval, and always flooding.

Since the problem started I was prescribed Tranexamic Acid which I find not very efficient. Has transvaginal ultrasound which found nothing amiss. Had to go to the A&E where I had a vaginal examination by a gynaecologist which again found nothing amiss and I was told I might have a Dysfunctional/ abnormal Uterine Bleeding, but had to have a proper appointment to be assessed more thoroughly. Managed at last to have a phone "consultation" with a gynaecologist who told me I needed a hysteroscopy, although when that will be possible I don't know as I am now on the waiting list and things are very slow with the current situation.

I'm 37 with two DC, 7 and 3, vaginal births. No hormonal birth control. No major change in my life. I am taking multivitamins + iron supplements after a blood test found I had low haemoglobin after my first bout of flooding. I am at my wits end and it's affecting every area of my life.

Why do I need a hysterescopy when a vaginal ultrasound and exam didn't find anything? What may be the cause? What are the alternatives to the Mirena coil? How can I manage the bleeding as nothing seems to work?

OP, you have no idea of anyone's qualifications or experience on the internet so please don't take medical advice from anyone on here.

Seek a second opinion from a real life professional.

I hope it gets sorted soon.

If you search on here keyword Ablation, the was a very recent thread on this, although there are several altogether.

This is an extremely common problem, hormones going haywire after children, perimenopause etc etc.

Most women wait years or are made to wait because it's just one of those things, but if your u/s was fine in theory you should be a good candidate for endometrial ablation. Contraindications can include fibroids, adenomyosis, and obviously any suspect growth.

Have a search, read up on it all. Mirena works for some women but anyone who had trouble with other hormone based contraception often find it also plays havoc with mood and weight. Some have said the bleeding was too bad and it couldn't stay put.

You will find horror stories for all options, but toy can do something about it, so don't settle for for being hushed.

Caveat: not a professional, just a patient who went through this for 6 years, and after opening up to friends found all sorts of info! Good luck.

Ps not everything can be found with an ultrasound and exam. My gynaecologists booked me in for a hysteroscopy, and potentially ablation, depending on what they found when they got in there. Had the ablation, and period free for the last 4 years or so.

@lborgia thanks a lot for your input. May I ask what was the cause of the bleeding in your case and how old were you? What happened during the hysterescopy? Did you have any anaesthetic? Did they perform the ablation the same day? How was it?

As Lockhart said, nobody can diagnose you here. And I am no expert.

Here's just some general advice:
Dysfunctional uterine bleeding is the most common cause of irregular bleeding in women in their 30s and 40s.
An ultrasound scan gives different information than a hysteroscopy and biopsies: one is pretty pictures, the other is direct vision + histology (microscopic) information.
Medicine often/always resembles detective work, you follow one clue to the next. Most investigations are there to rule out the nasty stuff, and a 'functional' (ie to do with how things work) diagnosis can only be made with confidence when 'structural' (ie how things look/the shape of things) problems have been ruled out.

With regards how to manage DUB, if that is indeed what it turns out to be, there are many options, Mirena IUS being one of them, and quite rightly a popular one. How well any method will agree with you and work for you, you'll only ever know once you've tried it out. Doctors can tell you numbers ("This works for 95% of patients") but they cannot tell you whether you are going to be one of the 95% or one of the 5%. Trying a new method is always a leap of faith - read up about it and then take a pick and try it out.

Very best of luck, I hope you get it sorted out quickly.

I think mine was hormonal, because I was absolutely clockwork for 30 years, and then from 12 weeks after 2nd child, boom, 3 up to 6 weeks of bleeding with 4-10 days off in between. It was hideous.

I tried everything non- interventional, and finally gritted my teeth. I'm very lucky that I had a brilliant doctor, and also here it's really easy to be referred. They were really thorough because of family history of gynae cancer, and I still have an ultrasound every so often, but it's been incredibly life changing.

So I was 40 when it started, 46 when I had the OP, and have just discovered I've tipped into menopause this year without realising what it was.

So I would've had at least another 4 years of the bleeding. Wish I'd had it done long before.

There are figures for the number of ablation that eventually need hysterectomy, but it's difficult to tell how many of those might've needed one in the end anyway.

I'm hugely relieved I didn't need one, and have several friends who are similarly delighted.

Never seek medical advice on a public forum. If you are unhappy or uncomfortable with your current gynaecologist, ask to be referred to a different one or request a second opinion.

I know what others mean when they say don’t ask for medical advice on internet, but... With my gynae problems, NHS doctors told me for years that nothing was wrong and eventually using internet research I managed to work out the problem myself and then had that diagnosis confirmed through a private consultant who did the appropriate surgery and found a big mess inside me. It took years and left me with lasting problems that I wouldn’t have had if my patronising male GP and his gynae friend hadn’t been so dismissive of my symptoms.

I have no confidence at all in NHS gynaecologists, for me, the internet had more value and the NHS advice was actually worse than no advice.

Anyway.

The hysteroscopy will see on close up camera stuff that an ultrasound can’t. Ultrasounds are very blurry and NHS ones tend not to even be in colour. Which can be v important to see tissue damage.

(Interesting you mention the Mirena, I tried that for a while and bled the entire time, not as bad as you tho. I had it taken out after a few months and went back to condoms.)

My advice to you is:

• ask if the NHS will pay for you to have a hysteroscopy asap with a private doctor under the ‘choose and book’ scheme (this is v common)
• if they won’t and you can afford it, get a private hysteroscopy or at least a private colour transvaginal ultrasound
• get the Mirena out or at least google “Mirena lawsuit”
• if you are ever in Spain/Greece/USA, get an opinion there as they are far ahead of UK in gynaecology

As to what happens during the hysteroscopy:

• general anaesthetic
• your stomach is inflated with gas (and possibly womb inflated with fluid)
• they make 3 tiny cuts: one at belly button (camera goes in here) and one each side of womb (instruments go in here so they can move organs out of way or cut internal tissue if needed)
• about 5 days later you will feel very sleeeeeepy
• be careful with yourself for a while, I fainted at 4 weeks after and the nurse said “oh yes that’s very common with a hysteroscopy” would have been nice if they’d told me that! I wouldn’t have stood so close to train platform edge! Luckily I managed not to fall onto tracks tho.

After you wake up your belly is a bit swollen for a while and you will have some shoulder pain because the gas dissipating inside your body puts pressure on a nerve that goes up to your shoulder. This pain however is MUCH better if you stay lying down asmuch as poss for a couple of days after surgery. Whether you have any other pain depends on if they found anything that needed work.

I’ve made it sound worse than it is, really wasn’t too bad, IVF hurt loads more. And the best thing is that you FINALLY know what is going on inside you. Ask to see photos, they will take these but probably won’t offer them unless asked.

My scars from the hysteroscopy are about 1cm long and not noticeable.

If it's possible for you to see a private gynaecologist, think about that because in all honesty the waiting lists local to me were incredibly long and I got to the point where I'd be out of breath climbing the stairs as I was losing so much blood daily. I couldn't walk the dogs, ride a bike with the DC, I'd have to tell my Head Teacher each time I had a two week period because it would mean nipping to the bathroom at least 6/7 times a day to change and it was just humiliating, forever worrying I'd flood.

I agree with PP's that nobody on here can diagnose, but I had ablation for exactly the same situation that you're in and although it really isn't for everyone (and you need to be absolutely sure you're finished having DC because there's no reversal) it has been such an amazing thing for me.

Hysteroscopy wasn't terrible at all - I had that done privately, too, and have the faintest scars on the top of my bikini line and one inside my bellybutton, but aside from that nothing. If you do have it done, buy some peppermint tea and drink it religiously as it helps the gases from your abdomen disperse (it can cause pain like trapped wind for a while).

*As to what happens during the hysteroscopy:

• general anaesthetic
• your stomach is inflated with gas (and possibly womb inflated with fluid)
• they make 3 tiny cuts: one at belly button (camera goes in here) and one each side of womb (instruments go in here so they can move organs out of way or cut internal tissue if needed)
• about 5 days later you will feel very sleeeeeepy
• be careful with yourself for a while, I fainted at 4 weeks after and the nurse said “oh yes that’s very common with a hysteroscopy” would have been nice if they’d told me that! I wouldn’t have stood so close to train platform edge! Luckily I managed not to fall onto tracks tho.*

Isn't that a laparascopy? Hysteroscopy is a scope inserted into the uterus, not the belly. Sadly the NHS sees fit to perform this in theatre on women with no anaesthetic in some trusts, which seems utterly barbaric. You seem to be describing a lap procedure, which is usually used to diagnose and treat adhesions, usually from endometriosis.

At any rate, everyone responds differently to GAs. Some people, myself included, don't feel sleepy at all after one, even longer ones, ever.

It's shocking that so many women are left to bleed this much. NO man would be, that's for sure.

OP, you have no idea of anyone's qualifications or experience on the internet so please don't take medical advice from anyone on here.

Although this is true, I have found way more expertise on the Mumsnet boards than I have IRL. My DS's neurological condition, that had doctors stumped for years, was correctly diagnosed within minutes of posting on here.

Don't underestimate the intelligence and expertise of your fellow Mumsnetters. Obviously one needs to consult with real life professionals, but there is nothing wrong with also seeking advice on here.

be vary careful of tranexamic acid - I was prescribed it for over a year in increasingly heavy doses because the periods remained the same - and then it did exactly what it was supposed to and stopped the blood - in my leg, so had to be treated for DVT.

Not sure about the description of hysteroscopy above - the hysteroscope is passed to the womb through the vagina, no scars. Had it done under general anaesthetic, and mirena fitted at the same time. The mirena was brilliant, I think I had one very light bleed after that, then never had another period.

If the ultrasound didn't pick anything up, I presume that the suggested hysteroscopy is to have a more detailed look. Nothing to worry about, a day procedure, although I find it takes a few days to properly get over the anaesthetic. The first occasion I went to an interview the following day, which involved a long journey and nearly passed out when there; I think they thought I had a hangover - I didn't get the job.

For me, the underlying problem was fibroids (which had been picked up by the ultrasound and physical examination), and a thickened womb lining, which hadn't been known about until after the hysteroscopy.

I found the only way to get my GP to take it seriously was to read the NICE guidelines on heavy periods, so that I was well informed and she couldn't fob me off. It also meant that I knew of other potential options when consultants leapt to the hysterectomy option. (bet they wouldn't be so fast to chop a blokes penis off if it was a male problem )

www.nice.org.uk/guidance/ng88
I also switched to using a moon cup - this enabled me to quantify how much blood with each period, by that stage up to a litre, rather than just saying "heavy period".

It was a long process, about three years all in all - do keep on at your GP and consultant{s) to keep the process moving, and don't be fobbed off.
Good luck with it all, hope it goes well.

Hystersocopy is a direct vision investigation of the uterus and is done via the vagina - no abdominal cuts of any kind.

'Colour' ultrasound - this is a form of duplex ultrasound where the computer displays the direction of flow (usually blood) in colour. It is not like black/white TV vs colour TV.

Tranexamic acid/Mirena/any other medical intervention carries risks as well as benefits. NOBODY can predict how any individual will react to anything. RL advice will enable to weight all options and make a decision.
There is no doubt that Mirena has saved thousands of women from needing a hysterectomy, but it does not agree/work for everybody.

Please don't be put off any method or encouraged in to anything by other people's personal experience as described on any internet forum.

I agree with PP, if you are unhappy with your current care ask for a second opinion. Contrary what people believe, private care is not better, it certainly is quicker, so do consider it if this is an option for you.

Also experience similar, mine was diagnosed as due to fibroids, initially diagnosed through ultrasound. I tried tranexamic acid and a mirena coil. I bled almost daily with the mirena and even with taking TA as well I could still flood a super tampax in an hour. My mirena is assumed to have come out during a particularly heavy bleed that saw me in A&E one morning. I went private (had insurance through work) due to the waiting time on the NHS and had an MRI then a hysteroscopy done under general anaesthetic and from that they recommended uterine artery embolisation which basically blocks off the blood supply to the fibroids. Had the whole lot sorted in just over 3 months from initial consultation, and that included 2 weeks over Xmas when nothing happened. Really happy with the results so far but if you're self funding I think my medical bill is probably in excess of £5000.
I wasn't suitable for an ablation due to the location of the fibroids but if you're done with having children then it seems to be a good option. I know a couple of people who've had it done and said it worked well for them.

Hello @All

Thanks so much for all your advice and especially for sharing your experiences. By posting here I wasn't questioning the consultant's decision about hysteroscopy but rather seeking to understand better my current situation and the possible treatments. I feel foolish now but at the time I felt that I took too much of the gynaecologist time over the phone telling them about my history over the past 7 months, so that when they suggested hysteroscopy and told me briefly what it was I didn't ask any other question I really do feel that I wasted the opportunity to ask all the questions I had, considering that I waited so long to be able to talk to a specialist...Oh well, I blame my sleepless week due to the heatwave!

Also, I'd be really grateful if anyone who tried natural treatments (herbs, lifestyle changes, etc.) which worked could share them with me so that I could research them. I always favour natural treatments if possible but will always turn to traditional medicine when needed.

Thank you

You need to find out what the cause of your heavy, irregular bleeding is, then decide between the different treatment options.

I don't know about herbal medicine for your problem.
Weight loss can help to make bleeds less heavy.

Re 'wasting time': you are not wasting anybody's time. A gynaecologist is the appropriate person take this further. They cannot tell on a first meeting, even if it had been in RL, what may need to be done, so further investigations is the way to go.
Best of luck, I hope you get it sorted quickly.

Oh, tip tip for dealing with long-awaited and often short hospital appointments:
Keep a note book. Write down questions as they occur to you. Ask them at the time, ideally have somebody with you as 2 sets of ears hear more than 1. Take bullet points of answers down also - it is well known that a lot of what gets said in a consultation is not retained.

No doctor worth their salt mids patients coming with questions, follow-up questions and who keeps an aide memoire of answers.

minds
Sorry

You may have endometriosis, I was like this, had a hysteroscopy & laparoscopy & my consultant found my ovaries & tubes were virtually all grey & stuck to everything else, I had patches of endo on my bowel as well where everything was stuck together. I was put on norethistoerone to stop my periods & 6 months later had a keyhole hysterectomy.

I used herbal medicine at one point, and it did help, a lot, but only for as long asd I was taking it, and frankly it wasn't enough of a change for me to contemplate taking it for 15 years.

Good luck!

Previous posters are describing a laparoscopy on here, not a hysteroscopy.

No good medical professional will give their opinion on your condition on here, it isn't worth their registration (I mean this in the nicest way possible!)