Dr Ahmed Ismail

Consultant Gynaecologist & Fertility Expert

The hot balloon that ends misery of heavy periods 
05 May 2010

A new 'hot balloon' treatment for heavy periods can be highly effective, a new study has found. The procedure - an alternative to the more radical treatment of hysterectomy - has a success rate of up to 90 per cent 

Heavy menstrual bleeding - or menorrhagia - affects millions of women. In the UK, an estimated one in 20 women aged 30 to 49 years consults her GP each year with the problem, which adds up to 1.5 million women. 

Referrals for menstrual disorders account for about one in five of all referrals to specialist gynaecology services. 

The first line of treatment is with drugs to reduce blood flow. The most commonly prescribed are tranexamic acid and mefenamic acid. The Pill is also widely used because it reduces bleeding. 

Surgical treatment is usually offered to patients who do not respond to drug treatment. 

Hysterectomy - removing the womb as a whole or in part - is the only treatment that guarantees a cure, ie the end of periods. 

However, hysterectomy is major surgery, and although complications are not common, they can include future incontinence through damage to the pelvic nerves or pelvic support structures. 

Balloon thermal endometrial ablation offers a less invasive alternative. 

The procedure involves placing a balloon into the uterus through the cervix. The balloon is inflated by filling it with a special solution, which is then heated to destroy the endometrium - the layer of tissue lining the womb which is shed every month in response to hormonal changes.

The procedure, which takes a few minutes, can often be carried out using local anaesthesia on a day-case basis. 

Previous research has suggested that the treatment could be highly effective. One trial reported that 12 months after the therapy, 73 per cent of the patients had normal bleeding; another trial reported a rate of 71 per cent. Now, a new larger study has reported an even higher success rate. 

The study at the Mayo Clinic in America, where around 250 women with menorrhagia had the procedure, showed that the failure rate at three years was around 11 per cent. 

Treatment failure was defined as a need to repeat the treatment, or the need for a hysterectomy, because of persistent bleeding or pain. 

The technique is not suitable for women who want to have children, although new research published in the journal Fertility-And Sterility shows that some women can become pregnant after the lining is destroyed. 

Commenting on the new findings, Dr Ahmed Ismail, consultant gynaecologist and obstetrician at Queensway Clinic, Harley Street, says: 'Balloon therapy is a very good and effective treatment for menorrhagia. 

'Most women will be helped with the contraceptive pill or other medications. Hysterectomy is a good, safe option, but many women are opposed to it.' 

He adds that it is very important that the patient's age and desire to have children are taken into consideration when deciding on treatment. 

'As with any method for menorrhagia that involves destroying the lining of the womb, it is ideal for the patient to be 40 or more and to have completed her family. 

' Women should approach endometrial ablation as if they were having a hysterectomy, and not plan to have any more children.' 

A new test could end the need for invasive surgery to diagnose endometriosis. Until now, there has been no other way of accurately diagnosing the condition, which can take years to detect. 

Endometriosis, which affects around two million women in the UK, is a condition in which the cells that usually line the womb are found elsewhere in the body, such as the fallopian tubes, ovaries or bladder. 

These endometrial cells behave in the same way as those lining the womb, so every month they grow during the menstrual cycle and then shed blood. With no way of leaving the body, this leads to pain, swelling and bleeding in the area affected. 

Diagnosis is usually made using a laparoscopy. This is carried out under a general anaesthetic and involves a special viewing tube being inserted through the navel to look for tell-tale signs. 

But laparoscopy can be associated with complications, including scar tissue formation. It is also costly. 

The new approach involves taking a tissue sample using an endoscope (or tube) via the vagina. 

This sample is then analysed to see how many nerve fibres it contains. This is based on the finding that the density of nerve fibres in women with endometriosis is about 14 times greater than in healthy women. 

'This test could help to reduce the current lengthy delay in diagnosis of the condition, as well as allowing more effective planning for formal surgical or long-term medical management,' said Dr Moamar Al-Jefout, one of the lead researchers in the joint Australian and Jordanian study.

For more information or an appointment at Queensway Gynaecology Clinic call:

Landline: 0207-935 55 40, 0207-935 66 00

English: 077 409 444 73, 077 457 481 88
Russian: 078 351 255 50, 078 351 255 51, 077 962 309 99, 077 450 461 44
Lithuanian: 077 962 309 99, 077 450 461 44
Arabic: 077 409 444 73, 077 457 481 88

Email: appointment (at) queensclinic.co.uk

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