What Can I Do About Heavy Menstrual Bleeding?

I always enjoy sharing these important issues with all of you.  It is so healing for us, as women, to realize that we do not suffer alone and that many others may share the same problems.  It is helpful to know that there is an answer or a way to get better.  If nothing else, these conversations bring understanding and validation.

Many of you are trying to deal with heavy cycles every month.  There are an estimated 10 million new cases of Heavy Menstrual Bleeding (HMB) in the United States every year!  So don't even think that you are alone. 

This has become such a problem, as it affects overall health and ability to just feel good and function at home and work.  It changes how women feel physically, and that affects emotions  - so their husbands and children are also impacted.  "Mom is always tired.  She doesn't act happy anymore and I think she is mad at me all the time."

For some women the bleeding comes only with your menstrual cycles, but it comes with such force and terrible cramping that it brings on nausea and vomiting - causing many of you to lose days from work every month.  Others of you just bleed heavily with little to no cramping, but the first 3 days of your cycle you don't dare leave the house and hope your work will be understanding AGAIN!

As women, we are used to having our cycles every month and actually are very sensitive to changes.  That's why things can get pretty horrible and out-of-control before some of you actually come in to seek help.  Our periods are like a fifth vital sign.  There's temperature, heart rate, blood pressure, respirations and, for women, our menstrual cycle.  Women come in all the time for 'emergency' appointments due to a missed cycle or because they had a double cycle.  The lucky ones have a one-time or occasional irregular cycle, immediately returning to normal.  Others of you are not so lucky and come in because the crazy, heavy cycle just got worse, and now you have been bleeding for 3 weeks straight (others even longer, like 3 months).

A THREE MONTH long period?  A three month long period with cramps and heavy, heavy bleeding with passage of strawberry- and cherry-sized blood clots?  Indeed.  The bleeding can get so strong that you use both tampons and pads, but the blood clots just push the tampons back out.  So off you go to sit on the toilet and let the clots and blood drip out, while you change your pad again for the 6^th or 8^th time that hour.   

This is 6-8 pads an hour for hours on end, with only a few hours of relief between bleeding episodes before it starts up again!  This can be how the first 2-3 days go.  It is no way to live, and over the past century treatment has come a long way.  Many women aren't interested in trying hormones or birth control pills, as they have tried them in the past without success.  Other forms of pharmacotherapy, which is what it is called, like non-steroidal anti-inflammatory drugs (such as Motrin, Advil and Aleve) or tranexamic acid are still considered first line treatment before a D & C or other forms of surgical treatment can be considered. Unfortunately, insurance companies make most of the medical decisions, and women have to "fail" hormone therapy before they can be approved for a surgical cure.  

Until the 1980s, the primary alternative to pharmacotherapy was a hysterectomy.  It is still a viable option and, for some, still the best decision.   Hysterectomy is a major operation, and if bleeding and pain are the only problem, endometrial ablation has become a preferred option.  So many women work and do not have the financial luxury of taking weeks off from work to recover.  The first ablations were attempted in 1930 with radio-frequency, but were not successful until 1981, when the Nd-Yag laser was used.  With endometrial ablation, a hysteroscopy can be performed beforehand to evaluate the inside of the uterus. Also, a D & C can be performed after the hysteroscopy (and before the ablation) so a tissue sample can be sent to pathology for evaluation and inspection.  Pictures are taken for documentation, which give the doctor and the patient an opportunity to go over the findings together.

The type of ablation performed is your choice.  Most will cause periods and the bleeding to go away, or at least return to a normal cycle.  Only 15% of women proceed to a hysterectomy after having an ablation, so this speaks for the success of the procedure. 

It’s important to note that excessive bleeding can also bring imbalance to the vaginal flora, so it is common to notice more vaginal odor and trouble with excess discharge.  I encourage all my patients to buy the WaterWorks system, as I have never found a better, natural, non-pharmacologic cure for these vaginal odor/discharge problems that are not due to infection.