Heavy Menstrual Periods

Heavy menstrual periods are a common reason for seeing the gynecologist.  There is not a consistent definition of what constitutes excessive bleeding.  If the bleeding is heavy enough to cause anemia (a drop in hemoglobin), it needs to be addressed and managed.  Any bleeding heavy enough to cause a change in activity or lifestyle changes is excessive and may need to be treated.

Abnormalities of the uterus and hormonal abnormalities are common causes of heavy menstrual bleeding.  If menstrual bleeding is heavy, you will need an examination to determine if a cause can be found. Sometimes special blood tests or an ultrasound are needed to determine the reason for the heaviness.

There is treatment available for heavy menstrual periods depending on the cause, your age, and your desire for future pregnancies.  If you are anemic, iron supplements will help build blood cells and may make you feel better.  If your blood count is normal, there are four options to consider. 

Observation: Heavy menstrual periods with a normal blood count do not require treatment.  If you can tolerate the flow, they are not dangerous to your overall health.  Over time, your menstrual periods may become lighter without treatment, or may become heavier.

Medication:  There are both hormonal and non-hormonal medications that may lesson your menstrual flow.  Birth control pills may be used to lessen the flow even if contraception is not needed.

Outpatient surgery: An endometrial ablation is an outpatient surgery in which the inner lining of the uterus is burned. The resultant scarring destroys the cells that form the menstrual lining of the uterus.  You can go home from the hospital the same day the procedure is performed, and are back to normal activities within several days.  The procedure is short, requires no incisions, and has a limited recovery.  The disadvantage of the procedure is that it is 80% successful, not 100%. It should not be used if future pregnancy is a consideration.

Hysterectomy: Hysterectomy means the removal of the uterus.  The ovaries, which produce hormone, are not always removed at the time of  hysterectomy.  The procedure will require a hospital stay of 3-5 days and a recovery of up to 6 weeks.  A hysterectomy is 100% successful in stopping menstrual periods, but requires a hospital stay and longer recovery.  In general, the risk of complications is higher than an endometrial ablation.