Heavy Menstrual Bleeding

Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman’s quality of life. It often leads to iron deficiency anaemia, which can result in a women feeling tired and weak. There are many causes of heavy periods, in general, these are divided into 3 main categories.

Enlarged multifibroid uterus

Enlarged adeomyotic uterus with adjacent ovarian cysts

Endometrial polyp

Hysteroscopy Fibroid

1. Uterine structural abnormalities
– Fibroids
– Endometrial polyps
– Endometrial hyperplasia
– Adenomyosis

2. Hormone related issues
– Polycystic Ovarian Syndrome (PCOS)
– Peri-menopause
– Underactive thryroid

3. Blood disorders (uncommon)
– Genetic clotting disorders
– Blood thinners

The first step in investigation of heavy menstrual bleeding is a high quality trans-vaginal pelvic ultrasound and review with a gynaecologist. Dr Wetherell is happy to see you and investigate and manage any of the conditions above.

Management

This usually depends on the cause of the heavy bleeding. However, as with most things it can be divided in Medical and Surgical management strategies.

Medical:

1. Non-hormonal
– Non-steroidal anti-inflammatory medication (NSAID) – Mefemanic acid
– Tranexamic acid

2. Hormonal
– Progesterone – Norethisterone (temporary reduction in bleeding)
– Combined Oral Contraceptive Pill (COCP)
– Progesterone Only Pill (POP) – Slinda or Visanne
– Mirena or Kyleena Intra-Uterine Contraceptive Device (IUCD)

3. Surgical
There are many surgical options, depending on the cause, including:
– Hysteroscopic endometrial polyp resection – Myosure or resectoscope
– Hysteroscopic resection of fibroid
– Endometrial ablation (Novasure)

  • This is where the lining of the womb is burned using radiofrequency energy to destroy the endometrium.
  • The endometrium is then scarred, which reduces or stops bleeding.
  • This is not usually suitable if you have large fibroids or adenomyosis.

– Laparoscopic myomectomy
– Laparoscopic hysterectomy

Each woman with heavy periods is unique and needs a tailored consultation and specific management plan. Dr Wetherell will work closely with you to investigate, diagnose and offer you up to date evidence based medical and surgical treatment options.

DR. LIMA WETHERELL

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PERSONAL VALUES

Integrity

“Evidence-based medicine guides every decision I make, ensuring my patients receive the most current, effective, and ethical treatments available"

Expertise

"As a high-volume advanced laparoscopic surgeon, I bring precision, experience, and a commitment to excellence in minimally invasive pelvic surgery"

Comfort

“My consulting suite at Epworth Freemasons offers a modern, luxurious, and welcoming environment for patients to feel relaxed and supported”

Respect

“With a warm bedside manner and meticulous attention to detail, I strive to create a safe, respectful space for women seeking expert gynaecological care”

Compassion

"Kindness and compassion are the cornerstones of my practice, where every patient receives thoughtful, evidence-based care tailored to their individual needs"
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INTRODUCING DR. LIMA WETHERELL

MBBS BBiomedSci FRANZCOG MRMed AGES Fellowship

Dr Lima Wetherell is a highly trained Melbourne based Gynaecologist and Advanced Laparoscopic Surgeon. She has completed an additional two years of training in advanced laparoscopic surgery via the highly regarded national AGES (Australasian Gynaecological Endoscopy and Surgery) Fellowship program at Monash Health. This is a high case load National formal training program in advanced pelvic surgery that focuses on laparoscopic management of endometriosis, fibroids, hysterectomy and other complex cases referred to a tertiary referral network. She is a specialist minimally invasive surgeon with her main areas of interest being laparoscopic surgical management of endometriosis, fibroids, heavy menstrual bleeding requiring hysterectomy and fertility surgery. She performs complex pelvic surgery with a high level of attention to detail. Lima prides herself on having an understanding and caring bedside manner, with a patient centred approach being the focus of her consultations. Each appointment is tailored to the specific needs of the patient with a focus on multidisciplinary management.

Lima grew up in the South Eastern suburbs of Melbourne, graduating from medical school at the University of Melbourne in 2012. After this, she completed her specialist training as an Obstetrician and Gynaecologist obtaining her FRANZCOG at the Royal Women’s Hospital in 2021. She then pursued further training by completing her AGES Fellowship at Monash Health and consolidating her skills in minimally invasive surgery. She has also completed her Masters of Reproductive Medicine from the University of New South Wales. Throughout this time Lima has been involved in research and clinical studies and is the principal author on a number of published studies.

Lima currently holds a public appointment at Monash Health, with both clinics and theatre lists across all four campuses, working in the Endosurgical Department. In her spare time Lima likes to spend time with her two beautiful children and husband, who is also a surgeon.