As many women delay pregnancy until later in life, they may encounter heavy menstrual bleeding while still wishing to preserve their fertility. Some may experience both heavy menstrual bleeding and subfertility as they age.
While these patients are often cautious in undertaking treatment for their heavy menstrual bleeding, there are many options available to them that will not impact fertility.
A hysteroscopy is essential for women who have subfertility and heavy menstrual bleeding. Up to 25 per cent have lesions such as endometrial polyps and submucosal fibroids. Submucosal fibroids can be treated by resection at hysteroscopy, both preserving and enhancing fertility. Polyps are easily removed at hysteroscopy.
In the group of women with heavy menstrual bleeding and infertility who have no underlying pathology, particular drugs can be an option. Anti-inflammatory drugs such as Ponstan are also helpful.
Women with Polycystic Ovarian Syndrome (PCOS) who have irregular ovulatory cycles and heavy periods often respond to weight loss and, if they have insulin resistance, Metformin.
Prophylactic iron therapy is advised if ferritin levels are low or anaemia supervenes.
Overall, controlling heavy menstrual bleeding is often possible while preserving fertility. Treatment of uterine lesions and oral drug therapy will allow patients to conceive while controlling symptoms.
