Treatments for heavy bleeding are generally fairly simple. Some can be done in the office in as little as 90 seconds. Even hysterectomies are now done mostly as outpatient procedures via laparoscopy. You don't have to "put up" with heavy periods.
1. Hormonal imbalances: Usually too much estrogen relative to progesterone. Estrogen acts like fertilizer on the lining of the uterus, while progesterone acts like a lawn mower, trimming it down and letting you have your period. If your body become insulin resistant (hyperlink) (because of genetics, or weight gain, or both), or if you are not ovulating with every cycle, as happens in the perimenopause, then you produce too much estrogen, which causes the uterine lining to grow abnormally, and eventually begin to slough off as irregular, heavy and unpredictable bleeding.
3. Endometrial cancer and precancer: Risk factors for endometrial cancer include obesity, Type 2 diabetes, hypertension, too much estrogen relative to progesterone. These are the same risk factors that cause endometrial hyperplasia, an overgrowth of the endometrial lining, and endometrial hyperplasia with atypia, a precancer.
4. Chronic Endometritis: A chronic low grade infection of the uterine lining, often caused by bacteria ascending through the cervix from the vagina.
5. Bleeding Disorders: Although these don't typically cause abnormal uterine bleeding, they can certainly exacerbate it.
6. Thyroid Disorders: The thyroid has a complex relationship with the sex hormone system, and thyroid disorders are seen often with irregular periods.
Basic investigation of heavy periods is typically as follows:
1. Thorough history and physical exam
Please help us by printing and filling out a "Heavy Bleeding History" and bringing it with you to your visit. That will allow us to quickly review what your symptoms are and allow more time to discuss options.
2. PAP if not recently done, to rule out cervical problems as a cause for heavy bleeding
3. Bloodwork, including CBC, TSH, free T3, free T4, and iron studies, and sometimes labwork to rule out bleeding disorders, such as Von Willibrandt's Disease.
4. Occasionally, hormone testing can give useful information and may be added
5. Pelvic ultrasound, to rule out obvious tumors and anatomical abnormalities
6. Office hysteroscopy, a 10 minute procedure to look inside the uterus with a camera to rule out polyps, obtain a targeted biopsy, and assess the general size and shape of the inside of the uterus
This is a brief description of your options. You and your provider can discuss in detail what the best option is for you in your individual circumstances and tell you much more about the pros and cons of each.
1. Observation - If all the tests above are normal, it may be appropriate to observe and monitor
2. Hormone Balancing - This often works reasonably well if the bleeding problem is fairly mild. It can be done with hormonal management with progesterone, or with the oral contraceptive pills, or various other prescription hormones. Generally hormone balancing works better for irregular periods than for regular heavy periods.
3. Endometrial ablation- Ablations are minimally invasive procedures to remove the inside layer of the uterus that sheds and bleeds every month, giving you the bleeding symptoms. The typical ablation can be done in the office in less than an hour (usually less than 30 minutes), and downtime is minimal. 96% of women are satisfied with their procedures. Of those, 1/3 no longer have any bleeding, and 2/3 have some, but it is much lighter and more normal. About 4% of women are not happy with the results of their procedure. Novasure ablation is the most tried and true technique.
4. Laparoscopic supracervical hysterectomy (LaSH) - This is a surgery done through four tiny incisions, it's outpatient surgery, the recovery is just 7-10 days, the risks are far lower than with traditional hysterectomy, the ovaries are preserved so hormones don't change, and the vagina stays well supported. Click here to find out more. The surgery is sometimes performed inside an Invisishield bag to keep the abdomen protected while the uterus is being removed.
5. Traditional hysterectomy - is done through the vagina or the abdomen and has a 3-8 week recovery. Laparoscopic hysterectomy remains the most popular form of hysterectomy, although ACOG recommends vaginal surgery as the most cost effective. Traditional hysterectomy is typically performed for prolapse, cervical disease or cancer.
Debra Ravasia, updated 2017