Women's Healthcare Issues: 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 heavy periods, or menorrhagia (men-or-ra’-jah), as a menstrual cycle that causes you to change your normal activity level. A “normal” menstrual cycle lasts between 5-7 days, is usually heavier on the first couple of days, and then gradually becomes lighter. If you have longer or heavier cycles than “normal”, or they keep you from enjoying your usual activities, you may have menorrhagia.
What can cause your cycles to become heavier?
Sometimes this is attributed to the normal aging process. Sometimes it is due to structural changes such as the development or growth of polyps or fibroids in the uterus. Hormonal imbalances, such as fluctuations in ovarian or thyroid levels, might be the cause. Complications from pregnancies or other illnesses can also cause heavy cycles. Your OB-GYN provider is trained to evaluate these possibilities using lab tests and sonograms, and then is able to suggest appropriate treatment options.
What are some treatment options for heavy periods?
After taking a thorough history and performing an exam, your provider will discuss ALL options for treatment. Some options might be undesirable or unreasonable to you, but may be perfectly desirable or reasonable to others. Ask to hear all of your options, and you and your provider can decide which ones are right for you. Here are some of the options we may discuss with you:
- Do nothing. It may sound strange, but in many instances heavy cycles are not a life threatening condition. Close observation may all that is warranted. Some people feel that if medical problems will not cause them permanent harm or death they prefer not to do anything. This option may be best for you, or you may prefer other options.
- Medical Management. Usually this involves use of NSAIDs (non-steroidal anti- inflammatories), hormonal treatment, or other medications. The birth control pill, patch or ring can correct your female hormone imbalance and regulate your cycle. The Mirena IUD (intrauterine device) is recommended for heavy periods and works by supplying a small amount of progestin, similar to the female hormone progesterone, directly to the uterus to keep the uterine lining thin and bleeding to a minimum. It also provides reliable contraception for up to 5 years. Sometimes thyroid hormone replacement is needed to correct menstrual disorders.
- Hysteroscopy and 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 thin, lighted telescope (a hysteroscope) into your vagina and through the opening in your cervix. The doctor can look inside your uterus for any abnormalities. Then, a different instrument is used to scrape the inside of the uterus and remove the lining. This will hopefully control the excess bleeding. The removed tissue is sent to a pathologist for microscopic examination.
- 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 endometrium - the thinner the lining, the lighter the flow. Destroying as much of the endometrium as possible helps limit the amount of the menstrual flow, and can be accomplished using heat (thermal ablation) or cold (cryoablation). Endometrial ablation is usually performed in the 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 physicians recommend trying a more conservative treatment method before proceeding with major surgery. However, if it is time to consider a hysterectomy, you usually have three options: 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 minimally invasive laparoscopic hysterectomy (MI-TLH – also called “robotic assisted”) which utilizes small (less than 1 inch in length) incisions along the lower abdomen and navel. Your doctor will discuss the options they recommend are best for you.
As with any healthcare issue, you should always feel comfortable asking questions of your healthcare provider. 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 the decision you are most comfortable with.