Goodbye "Aunt Flo"

As a gynecologist, one of the most common medical problems that I encounter in my patients is heavy menstrual bleeding. It is estimated that one in five women ages 35-49 is affected by heavy periods. This translates to more than 10 million American women each year. Heavy periods consist of menstrual bleeding that lasts for more than 7 days. Other signs of heavy menstrual bleeding include bleeding that requires changing pads or tampons hourly or more often for several hours in a row, passing clots the size of a quarter or larger, needing to change pads or tampons during the night, or needing to wear both a pad and a tampon to prevent bleeding through onto your clothing. Heavy menstrual bleeding not only can negatively affect quality of life, it may lead to iron deficiency anemia, fatigue, and other health problems.

Many women begin to experience heavy menstrual bleeding in their 30s and 40s as their hormones start to change with perimenopause. It is common for heavy menstrual bleeding to affect women in a number of ways – not just physically. Many women with heavy menstrual bleeding also experience fatigue, nausea, severe cramping, and menstrual related headaches. More than 60% have had to miss social or athletic events. About 33% of these women have had to miss work due to the heaviness of their flow. The heavy menstrual bleeding can cause depression or moodiness in 77% of women and anxiety in 75%. 57% report a lack of confidence during their period.

Causes of heavy menstrual bleeding are varied and include a hormone imbalance, thyroid disease, and benign growths of the uterus like polyps and fibroids, malignant processes like uterine or cervical cancer, as well as certain medications such as blood thinners. The typical workup for heavy menstrual bleeding includes a physical examination and a series of simple tests. One of the initial tests that is done is blood work to check for anemia (low blood count), hormone imbalance, thyroid disorders, or occasionally for a bleeding disorder in which the body’s clotting mechanisms do not work normally. Other tests for heavy menstrual bleeding include a Pap smear to screen for cervical abnormalities and an endometrial biopsy that can diagnose uterine cancer, pre-cancer, or infection. An endometrial biopsy is a simple, in-office procedure that samples the lining of the uterus. It usually is very well tolerated and often feels like a brief menstrual cramp. Another common test for heavy menstrual bleeding is a pelvic sonogram (ultrasound). This test is painless and uses sound waves and a computer to show images of your uterus and ovaries. If the pelvic sonogram shows evidence of an endometrial (uterine) polyp, a more specialized sonogram called a sonohysterogram or saline sonogram may be performed. This type of sonogram is also done in the office and involves injecting a small amount of sterile saline into the uterine cavity via the cervix to better identify uterine polyps or fibroids. This test is very well tolerated and is associated with mild to moderate cramping and pressure. It is performed in a similar fashion to the Pap smear, using a vaginal speculum and a small catheter.

There are many effective treatment options for heavy menstrual bleeding. The treatments range from various drug therapies including hormones, intrauterine devices (IUDs), and other medications specifically designed to reduce menstrual blood loss. Progestin releasing IUDs like Mirena and Liletta have been shown to reduce menstrual bleeding by 80-90%. Therefore, IUDs are one of my favorite noninvasive ways to control excessive menstrual blood loss. They can be inserted in the office, can last for up to 3-5 years, and are quite cost effective over time. They also function as contraception.

Over the counter botanical options for heavy bleeding exist and can be quite effective. A few of my favorites are chaste berry and Shepherd’s purse. There are surgical treatment options that are effective in reducing menstrual blood loss, and I would like to concentrate on one procedure in particular – endometrial ablation. Endometrial ablation, also known as NovaSure, is a simple, one-time, five-minute procedure that has been used to treat over two million women, without hormones or hysterectomy. NovaSure endometrial ablation can reduce or stop menstrual bleeding. It works by permanently removing/cauterizing the endometrium (lining of the uterus that causes the bleeding) with a quick delivery of radiofrequency energy. With NovaSure, a slender wand is inserted into the uterine cavity. The wand then releases a triangular shaped netted device into the uterus. The netting expands, precisely fitting to the size and shape of your uterus. Precisely measured radiofrequency energy is delivered through the netting for about 90 seconds. The netted device is pulled back into the wand, and both are then removed from the uterus. No part of the NovaSure device remains inside the body after the procedure is completed. The NovaSure then reduces or stops menstrual bleeding in 90% of women that have it performed. NovaSure endometrial ablation is either performed as an outpatient procedure under IV sedation/general anesthesia or as an in-office procedure performed after administration of a local anesthetic.

NovaSure endometrial ablation is for premenopausal women with heavy periods due to benign causes who are finished with childbearing. It is not recommended to get pregnant after having the NovaSure procedure performed. The NovaSure procedure is not a sterilization procedure. Most women who have had the NovaSure have lighter periods or no periods afterwards. In a clinical study, 9 out of 10 women returned to normal or light periods, and 4 out of 10 women stopped bleeding altogether. Results of a clinical study show that after 12 months following the NovaSure procedure, 93% of patients were satisfied with the procedure and 97% said they would recommend the procedure to a friend.

If you are suffering with heavy menstrual bleeding and would like to learn more about what treatment options are ideal for you, call us today to schedule an appointment. Life is short – no need to waste any more of it on heavy bleeding!

To Your Health,

Dr. Couri