Most gynecologists will agree, it’s amazing what women adapt to. They will say something along the lines of, “My periods are 8-10 days long, and I have to buy the overnight pads, doubled up with super plus tampons. I usually feel fatigued and nauseous and have to take some time off of work. But that’s normal, right?” Ladies. Listen carefully. THIS IS NOT NORMAL. A period should be a monthly nuisance, not something that alters your life and something that you have to plan around. I have women that have to plan their vacations, wedding, family parties, all around their cycle. Again, this is not normal! Let’s discuss some options that you can then review with your gynecologist to get your life back.
Medical: The first option I usually try for women with irregular or heavy bleeding is birth control. There are a variety of types of hormonal regulation. I will discuss the most common ones below.
Birth Control Pills: in general, pills are the easiest and first line of therapy for heavy cycles. They are user dependent, meaning if not taken properly, they won’t work. Contraindications to taking the pill are uncontrolled hypertension or diabetes, smoking over the age of 35, migraines with aura and of course, pregnancy.
Depo Provera: Commonly refered to as “the shot”, depo provera is a progestin only form of birth control. It does NOT give a women regular or predictable bleeding, but after a few months the majority of women do not have their periods at all. I have had two patients whose anemia was so severe they had to be hospitalized for blood transfusions, and now they are bleeding free!
IntraUterine Device: There are a handful of intrauterine devices that control bleeding. They are also progestin only birth controls. It is a quick office procedure to get the device placed, and is tolerated very well by almost everyone. I lovingly refer to the procedure as “a pap on steroids”.
Surgical: If birth control does not work, or is not a feasible option for you, there is always surgery.
Dilation and Curettage: Some women just need their system to be “reset”. A D&C is a minor outpatient procedure that cleans out the inside of the uterus. It is not hormonal. This procedure is both therapeutic and diagnostic, because the tissue obtained gets sent to pathology and reviewed.
Operative hysteroscopy: An operative hysteroscopy is also a minor outpatient procedure. In this procedure, a camera is introduced into the uterus through the vagina. By doing this, we can then assess the uterine cavity and look for any abnormal polyps or fibroids, and removed them at the same time. Often, an operative hysteroscopy and a D&C are done together, and all the tissue is sent to pathology.
Endometrial Ablation: An endometrial ablation is performed to burn, or ablate, the lining of the uterus. It is for women who are done with childbearing. It can be done in the office or in the operating room.
Uterine Artery Embolization: One way to control uterine bleeding is by cutting off the uterus’ blood supply. In this procedure, radiologists embolize, or clot off, the main blood supply to the uterus. If there is no blood flow, there is no menstrual cycle. This is also only performed in women who are done with childbearing.
Finally, Hysterectomy: This is the most aggressive and most successful option for women who are bleeding, especially when all else fails. It is considered a major surgical procedure, however depending on each individual woman, can be done minimally invasive (small incisions, less recovery time, less hospital stay), but for some women it is necessary to make a bigger incision. This will be a discussion between yourself and your surgeon, based on each individual.
Bleeding every month is, unfortunately, a part of most women’s life. It does not need to take over your life though, and it definitely should not lead to missed work or school, extreme fatigue, anemia, exhaustion or the feeling that you have to plan around your monthly visit from Aunt Flo. This is not a totally inclusive list, so remember to discuss all concerns with your physician.