Treatment Options for Heavy or Prolonged Menstrual Periods

>> Thursday, October 30, 2014

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Heavy or prolonged menstrual periods, or menorrhagia, is the most common type of abnormal bleeding that women experience.  Periods are considered heavy if there is enough blood to soak a pad or tampon every hour for several consecutive hours.  Sometimes, it's nighttime bleeding that requires getting up to change pads or tampons or passing large blood clots.  And, when our periods last longer than 7 days with heavy bleeding, not spotting.  All of this can interfere with sleep and daily activities and lead to anemia, causing symptoms such as fatigue and shortness of breath.

As we have discussed, a balance between estrogen and progesterone regulates the buildup of the endometrial lining of the uterus, which is shed during menstruation.  If a hormone imbalance occurs, this lining can thicken too much, causing many menstrual irregularities.

Certain drugs, including anti-inflammatory medications like aspirin, and anticoagulants or blood thinners can contribute to heavy or prolonged menstrual bleeding.  Also, if someone has a blood coagulation disorder from birth, such as Von Willebrand's disease, the blood doesn't clot well.  There are other inherited disorders as well that can cause abnormal menstrual bleeding. The good thing is these are usually identified at the same time as the first period, because it will be very heavy.

There are a number of other medical conditions, including pelvic inflammatory disease (PID), thyroid problems, endometriosis, and liver or kidney disease, that may be associated with menorrhagia.  Also, fibroids, polyps or other noncancerous tumors of the uterus, and things like Adenomyosis, which is a condition that causes the glands from the lining of the uterus to become imbedded in the muscular wall of the uterus.  Of course, the worst case scenario would be some kind of female cancer like uterine, ovarian, or cervical cancer.  These are rare, but possible, causes of heavy menstrual bleeding.  Other medical conditions can prevent normal blood clotting, including liver, kidney, or thyroid disease, and bleeding or platelet disorders.

Treatment for menorrhagia once you have identified the reason, may include one or more of the following things:

  • The nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen can reduce the amount of blood loss and help with pain.
  • Lysteda (tranexamic acid), a non-hormonal medication that can also be prescribed to you because it promotes blood clotting and will significantly decrease blood loss.
  • Birth control pills or hormone therapy is a common method used to stabilize the endometrial lining of the uterus, regulate menstrual cycles, or correct hormonal imbalances.
  • The IUD Mirena is used for heavy bleeding and also prevents pregnancy.  It works by local progesterone absorption, not systemic absorption.  That means no hormone goes into the blood stream, so it doesn't affect or change our own hormone balance.  In fact women continue to ovulate and have their own natural hormone fluctuations.  Because this local absorption thins the lining of the uterus (endometrium), it makes periods very light, or absent.  This makes it a wonderful method for helping with heavy or irregular menstrual bleeding.  It is also effective in preventing pregnancy because it thickens the cervical mucus, or discharge, so much that the sperm cannot pass through the cervix to fertilize the egg.  This is a good choice for women who do not want surgery or who cannot or don't want to take hormones.

Many women have chosen more permanent procedures when they are done having children.  Endometrial ablation can be done in several ways like freezing, hot thermal balloon ablation, electro-cautery, and hot water.  This effectively cauterizes the endometrial lining so it won't build up monthly any more.  It can last 3-5 years and occasionally can be permanent.  It is considered a semi-permanent way to stop heavy menstrual or frequent/continuous vaginal bleeding.
Hysterectomy, which is complete removal of the uterus, as it is the uterus that bleeds.  Ovaries produce all the female hormones and can be removed, but if there is no pain problems, it is best to leave them for hormone support. 

Many women who have continuous or irregular bleeding can also have odor problems.  This happens because the vagina maintains health by being slightly acidic.  Blood is a higher, physiological pH and this will cause a rise in vaginal pH.  When this happens, yeast and abnormal vaginal bacteria overgrows and this brings abnormal odors and could lead to yeast or bacterial infections.

UsingWaterWorks during this time to rinse out the excess blood would help keep away unwanted orders.  It is safe to use daily, uses no chemicals and is FDA cleared to help with vaginal odor. :)

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