Treatments
Heavy bleeding and cycle problems
Heavy menstrual bleeding and cycle problems are common and can have a major impact on daily life. Women with these symptoms often feel they are not taken seriously. At Femmecare, we do take them seriously.
What is it?
What are heavy bleeding and cycle problems?
With heavy menstrual bleeding you lose a great deal of blood during your period, or bleed for a long time. This can lead to fatigue, anaemia or limitations at work and in social life.
Cycle problems are periods that are irregular, painful, too frequent or too infrequent. There is often an underlying cause, such as a hormonal imbalance, benign changes in the womb (such as polyps or fibroids) or disturbed ovulation.
Polyp or fibroidA benign change in the womb can be a cause. We can remove small polyps and fibroids here at the clinic.
In figures
You are not alone
Heavy bleeding is common, but far from everyone seeks help for it, even though good treatments exist.
- 10 to 35%of women report having heavy menstrual bleeding.
- 5%of these women see a doctor about it between the ages of 30 and 49.
- 9 in 10women with a hormonal coil lose much less blood.
- 77%of women in a study lost much less blood one year after treatment with the Cerene.
Sources (Dutch professional guidance): NVOG, Richtlijn Hevig menstrueel bloedverlies (2025); decision aid ‘Veel bloedverlies tijdens ongesteld zijn’ (NVOG and Bekkenbodem4All, 2023); study of 242 women, see the leaflet ‘Endometriumablatie met de Cerene’.
Symptoms
Which symptoms can you have?
Symptoms vary widely, for example:
- Excessive bleeding: flooding, passing clots or a long period
- Irregular periods
- Painful periods
- Bleeding between periods
- Fatigue, dizziness or breathlessness caused by anaemia
- A lower quality of life, or an impact on work, sport and social activities
Your visit
What does treatment involve?
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First consultation and examination
Treatment starts with a first consultation and physical examination by one of our specialist doctors, supplemented if needed by an ultrasound scan or blood tests for anaemia and iron deficiency.
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Looking inside the womb if needed
If the doctor suspects a polyp or fibroid, a hysteroscopy may follow: the doctor looks inside the womb with a thin camera. A small polyp or fibroid can be removed straight away.
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Treatment plan
Based on the findings we draw up a personal treatment plan together. Your wishes and your stage of life are central to this.
Treatment
Treatment options
There are many options. Together we discuss which suits you best, for example using the Dutch national decision aid.
Contraceptive pill
You take the pill every day. In around half of women the bleeding becomes much lighter.
Hormonal coil
The doctor places a hormonal coil in the womb. In 9 out of 10 women the bleeding becomes much lighter.
Medication without hormones
For example tranexamic acid or an anti-inflammatory painkiller, only on the days when bleeding is heaviest.
Endometrial ablation with the Cerene
The doctor freezes the lining of the womb using a soft balloon. We do this under local anaesthetic; you are at the clinic for about an hour.
Only for women who do not want (more) children.
Hysteroscopy
The doctor can remove small polyps or fibroids inside the womb with a thin camera, without an incision in the abdomen.
Lifestyle advice
Sometimes changes to your lifestyle can help reduce symptoms. We discuss what makes sense for you.
You can also choose not to treat your symptoms. We are happy to discuss that option too.
Good to know
What we do and do not do
Not at Femmecare
- Removal of the womb; for this we refer you to a hospital
- Removal of large polyps or fibroids; for this we refer you to a hospital
- Treatments under sedation or general anaesthetic
Available at Femmecare
- Investigation of the cause, with ultrasound and blood tests if needed
- Hysteroscopy, and removal of small polyps and fibroids
- Endometrial ablation with the Cerene, under local anaesthetic
- Fitting a hormonal coil
Our approach
What can you expect?
- Clarity quickly, and a clear diagnosis
- A tailored treatment plan that respects your preferences
- Fewer symptoms and more control over your periods and your life
See also
For GPs
Referring patients with heavy bleeding
Diagnosis and treatment of heavy menstrual bleeding and cycle problems in line with the Dutch NVOG guideline Hevig menstrueel bloedverlies (2025).
ZorgDomein: ‘Femmecare Clinics’
Reasons to refer
- HMB with insufficient response to treatment in primary care
- Suspected polyp or (submucosal) fibroid
- Request for endometrial ablation where the family is complete
- Difficult or failed fitting of a hormonal coil
What we offer
- Ultrasound; Hb, and with fatigue despite normal Hb also ferritin and MCV
- Outpatient hysteroscopy, diagnostic and operative (small polyps and fibroids)
- Endometrial ablation with the Cerene under local anaesthetic
- Fitting of a hormonal coil
Your symptoms taken seriously
Our aim is to make your menstrual symptoms manageable, so that your life does not have to revolve around your cycle. Would you like an appointment? First discuss with your GP whether a referral to Femmecare is appropriate.