Heavy Periods (or Heavy Menses)
Do you think your cycles might be excessively heavy or long?
The American College of
Obstetricians and Gynecologists (ACOG) defines menorrhagia (men-or-ra'-jah) as a menstrual
cycle that causes you to change your normal activity level. So if you think your cycle is too
long, then it probably is. What might be abnormal to you might be different to another woman.
A "normal" menstrual cycle lasts between 5-7 days, usually heavier on the first couple of days,
and then starts to get lighter after that.
What can cause your cycles to change, or become heavier?
It may just be the aging process,
with no other abnormalities being the reason. There could be structural changes such as the
development or growth of polyps or fibroids. Hormonal imbalances, such as fluctuations in ovarian
or thyroid levels, might account for the changes in your cycle. Complications from pregnancy
or other illnesses can also result in heavy cycles. Your Ob-Gyn is trained to evaluate these
possibilities using lab tests and sonograms and then be able to suggest different treatment options.
What are some of your options for treatment?
After a thorough evaluation is completed, your physician should discuss ALL your options for treatment,
regardless of how they might sound. What might seem undesirable or unreasonable to you might sound
perfectly desirable and reasonable to another patient, or vice versa. Ask to hear all your options,
and then you and your physician can decide which ones are right for you.
- Do Nothing. It sound s strange, but in most instances,
heavy cycles are not a life threatening condition. Close observation may be all that is
warranted. Some people feel if a medical problem is not going to cause them permanent harm
or death, then they don't want to do anything about it. This option may not be for you, but
for some, it is the best option for them.
- Medical Management. Usually this involves oral birth control
pills/IUD or thyroid hormone replacement if your thyroid level is not at a correct level.
The birth control pills can correct your female hormone imbalance and regulate your cycle.
The Mirena IUD has a small amount of female hormones that stay in your uterus, can lighten
your cycle, and provide reliable contraception for up to 5 years. Thyroid hormone replacement,
if needed, can correct some menstrual abnormalities.
- Hysteroscopy, D & C. Hysteroscopy, Dilation and Curettage (D&C),
is an outpatient procedure performed in an ambulatory surgery center. You are put to sleep for about
20 minutes and your Ob-Gyn places a lighted telescope (a hysterscope) through your vagina and cervix,
and looks to inside your uterus to see if there are any visible abnormalities inside. Then a different
instrument is used to perform a scrapping of the lining of the uterus to remove the lining and hopefully
control the bleeding. The scrapings are sent to the pathologist to examine microscopically for any
abnormalities.
- Endometrial Ablation. This is a procedure that disrupts and destroys as
much of the lining (endometrium) of the uterus as possible. The amount of menstrual flow is usually
proportional to the thickness of the endometrial lining. If there is less lining, then there is usually
less flow. By destroying as much of the endometrium as possible, it will limit the amount of the
menstrual flow. This can be accomplished using heat (burning) or cold (freezing). It is usually performed
in your doctor's office or in an ambulatory surgery center. You and your doctor can decide which method
is best for you.
- Hysterectomy. This is the most invasive method available to you. Most
reputable physicians will recommend trying a more conservative treatment method before proceeding
with major surgery. If however, it is time to consider a hysterectomy, you usually have three options on
the type of hysterectomy. The traditional total abdominal hysterectomy (TAH) with either a bikini line or up
and down incision; a total vaginal hysterectomy (TVH) with no incisions on the abdomen; or the new
total laparoscopic hysterectomy (TLH), utilizing small (less than 1 inch in length) incisions along
the lower abdomen. Your doctor can discuss each option and which one might be best for you.
You should always feel comfortable asking questions of your physician. Never hesitate to get a second
opinion from another physician. Only in rare conditions does an immediate decision need to be made.
Take your time to make a decision so you feel comfortable with it.
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