Treatment Options for Heavy Periods

Are you ruining your underwear and bed sheets?

Are you changing your plans to avoid embarrassing “accidents” during your period?

Are you tired of your heavy periods ruling your life?

If you answered yes to any of these questions it is important that you discuss your abnormal uterine bleeding with your gynecologist.

Your gynecologist will ask you questions and likely perform a physical examination. She may also order some additional testing to determine if you have an underlying condition that may be causing the abnormal bleeding.

It is possible that your heavy or prolonged menstrual bleeding has caused you to develop anemia. If this has happened to you, your gynecologist may suggest that you eat certain foods that are rich in iron. She may also recommend that you start taking an iron supplement. Increasing the iron in your diet will help your body correct the anemia. Occasionally the bleeding is so heavy and the anemia is so significant that you may need a blood transfusion.

There are several options for the management of heavy menstrual bleeding. Your gynecologist will help you select the treatment options that are right for you.

Underlying medical condition

Speaking to your gynecologist about your heavy menstrual bleeding is important. It can occasionally lead to the diagnosis of an underlying medical condition.

Bleeding disorders, particularly Von Willebrand disease, can be a common underlying cause of heavy menstrual bleeding.

Liver disease and a condition called thrombocytopenia can also result in heavier menstrual bleeding. Thyroid dysfunction, especially an underactive thyroid condition or hypothyroidism can cause heavy menstrual bleeding

Treating the underlying medical problem can sometimes help improve your abnormal uterine bleeding.

Structural changes in your uterus

When your gynecologist finished evaluating your heavy menstrual bleeding she may have diagnosed you with an endometrial polyp or a submucosal uterine fibroid. If you have been diagnosed with one of these changes to your uterus then a procedure may be recommended.

One option that will likely be discussed with you is hysteroscopy. This is a minimally invasive surgical procedure performed with a camera and surgical instruments passing through your vagina and cervix into your uterus.  It is a day surgical procedure and usually does not involve an overnight stay in the hospital. Using this procedure a polyp or a submucosal fibroid can be easily removed.

Another option for the treatment of a submucosal uterine fibroid is a procedure called Uterine Artery Embolization (UAE)

No underlying pathology

It is common for all of the diagnostic testing to come back normal. In this case, there is no underlying cause of your heavy menstrual bleeding. Treatment options usually start with medications.

Contraceptive steroid hormones are used to help thin the lining of the uterus or the endometrium. They also have the benefit of providing contraception. Options that your gynecologist may suggest include:

Oral contraceptive pill

Depo Provera

Nexplanon

Mirena

If contraception is not necessary your gynecologist may have you take oral progesterone only for a certain number of days each month to thin out the lining of your uterus.

In addition to the hormonal options, nonhormonal options are available. These may be appropriate in certain clinical situations.

Nonsteroidal anti-inflammatory drugs or NSAIDs have been shown to help reduce heavy menstrual bleeding by decreasing the amount of prostaglandins produced by the uterus. There is no evidence to suggest that one NSAID is better than another in decreasing heavy menstrual bleeding.

Tranexamic acid (Lysteda) is another nonhormonal option.  This medication interacts with your body’s natural blood clotting mechanism to decrease heavy menstrual bleeding.

It is important that you speak with your gynecologist to determine what medicine may be right for you.

Usually, your gynecologist will recommend a three to six month trial of medications to control your abnormal uterine bleeding. If you continue to have heavy menstrual bleeding it is important to discuss this with your gynecologist. In this case, your gynecologist will likely recommend additional testing such as an endometrial biopsy or hysteroscopy. You gynecologist may also offer you more definitive surgical treatment such as an endometrial ablation or hysterectomy.

Continue Reading