Have your periods gotten so heavy that you now worry about where you sit for fear of leakage? Are you changing your pad or tampon more than six times a day or waking up at night to do so? Is excessive bleeding interfering with day-to-day activities?
According to Linda D. Bradley, MD, director of the Center for Menstrual Disorders, Fibroids and Hysteroscopic Services at the Cleveland Clinic, a single heavy period is not cause for concern… but if you generally answer yes to any of the questions above, it’s time to see your gynecologist. Fact of life: Menorrhagia (men-uh-RAY-jee-uh), the medical term for excessive menstrual bleeding, is common during perimenopause (the years leading up to menopause). But there are treatment options, including a newly approved nonhormonal medication, to prevent periods from getting in the way of your life.
To help with the diagnosis, be prepared to tell your doctor…
Most midlife menorrhagia is caused by one of the following…
Hormonal and ovulatory changes. The dramatic fluctuations in estrogen and progesterone levels and the episodes of intermittent anovulation (absence of ovulation) that typically occur during perimenopause can lead to heavy and erratic periods, Dr. Bradley said.
Obesity. Belly and buttocks fat convert a hormone called androstenedione into estrogen, creating an estrogen excess that triggers heavy periods. Obesity also disrupts communication between the brain and the ovaries and uterus.
Endometrial polyps. An overgrowth of endometrial cells, polyps usually are pea-sized or smaller but can grow to the size of a lemon. Additional symptoms include irregular periods and spotting between periods or after sex. Polyps that cause symptoms should be surgically removed and also checked for cancer, Dr. Bradley said, though fortunately most are benign.
Fibroids. These tough knots of muscle and connective tissue can grow on the inside or outside of the uterus or within the muscular uterine wall. They may cause pelvic pressure or pain. Most are small, but some are as large as a basketball. Doctors aren’t sure why fibroids cause heavy bleeding, but it may be because fibroids increase the surface area of the uterine cavity and/or secrete chemicals called prostaglandins that affect bleeding.
Adenomyosis. This occurs when endometrial tissue grows within the uterine wall. Symptoms, which typically worsen with age, may include severe cramps, bleeding between periods and painful intercourse.
Often menorrhagia can be treated without resorting to surgery. What to discuss with your doctor…
Lifestyle changes. Stress can lead to changes in menstruation, so stress-lowering techniques, such as meditation or yoga, may help reduce bleeding from various causes. When obesity is the trigger, weight loss can ease or even eliminate menorrhagia, Dr. Bradley said.
Birth control pills. Within three months of starting oral contraceptives, 70% to 90% of users have decreased menstrual bleeding. Birth control pills may help patients whose menorrhagia is due to any of the conditions above except polyps.
Prescription-strength nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin) and meclofenamate (Meclomen). Taken during menstrual periods, these medications not only ease pain, they also reduce prostaglandins and thus decrease bleeding in patients with fibroids or adenomyosis. Caution: NSAIDs increase the risk for cardiovascular and gastrointestinal problems.
Lysteda (tranexamic acid). This is the first nonhormonal prescription drug approved for menorrhagia due to various causes. Taken during your period, it works by inhibiting the abnormal breakdown of blood clots, reducing bleeding by about one-third without affecting fertility. Caution: Lysteda can increase the risk for blood clots when taken with hormonal contraceptives or certain other medications.
Mirena (levonorgestrel). This hormone-releasing intrauterine device (IUD) has been used as a contraceptive for a decade and was recently FDA-approved to treat menorrhagia. Possible side effects include abdominal pain and an increased risk for pelvic inflammatory disease.
If the above treatments are inappropriate or ineffective, your doctor may recommend surgery. Possible options…
Operative hysteroscopy. The doctor inserts a lighted scope into the uterus via the vagina, then surgically removes polyps or fibroids using a cutting or cauterizing device. This outpatient procedure has a two-day recovery time and preserves fertility. Growths that are removed do not grow back, but new ones may form.
Uterine artery embolization. This fibroid treatment involves injecting substances that close off arteries that feed the fibroids, causing them to shrink over time. Typically it requires an overnight hospital stay and a one-week recovery. Fertility may be compromised… fibroids may recur.
Endometrial ablation. With this minimally invasive procedure, a device that utilizes heated fluid, microwaves or other technology destroys a thin layer of the uterine lining, stopping or significantly reducing menstrual flow. According to Dr. Bradley, this outpatient or office procedure typically is used to treat unexplained menorrhagia. Endometrial ablation involves a recovery time of one to two days… and usually ends a woman’s fertility.
Hysterectomy. When all else fails, a woman with severe menorrhagia may want to consider surgical removal of the uterus. Hysterectomy involves a one- to two-day hospital stay. Recovery takes about two weeks if the uterus is removed vaginally or laparoscopically… or four to six weeks if an abdominal incision is required.
