Heavy menstrual periods can create a troublesome quality-of-life issue for many women.  Once a woman has completed her childbearing, it can seem rather ridiculous to endure excessive menstrual bleeding month after month.  Anemia, fatigue, and having to wear lots of dark clothing during “that time of the month” are common complaints we hear among sufferers.

New technology has tremendously enhanced the options that women now have available to address heavy bleeding.  It used to be that hysterectomy or medications with sundry side effects were the only viable options.  Many of these new procedures can be performed right in the office with minimal downtime.  Even if hysterectomy ends up being a woman’s best option, most can be done vaginally or even laparoscopically -- requiring less recovery time.

Heavy bleeding often results from excessive build-up of the lining of the uterus.  This can be due to hormonal imbalances or anatomic changes such as fibroids or uterine polyps.  These changes typically occur in a woman's 30s or 40s.  Once the cause for heavy bleeding is determined through an exam and pelvic ultrasound, dialogue for treatment can be entered.

Therapy that addresses excessive lining build-up includes insertion of a hormone-containing IUD (intrauterine device).  The IUD delivers a small amount of hormone right to the uterine lining, resulting in thinning of the lining and much lighter subsequent cycles.  Because the bloodstream absorbs very little of the hormone, there are few systemic side effects.  Even women who have had difficulty with oral contraceptives in the past generally tolerate the hormone-containing IUD --  making it an excellent option for those who are uncertain about desiring future pregnancy but who need contraception and cycle control.  Patients who have completed childbearing simply appreciate the menstrual flow reduction.  The IUD placement is a simple office procedure that takes fewer than 10 minutes.

Another extremely effective treatment is endometrial ablation.  The endometrium is the layer of tissue inside the uterus that responds each month to the fluctuation of hormones.  In this procedure, a small catheter placed inside the uterine cavity is filled with fluid.  The fluid is then heated, causing thermal damage to the lining of the uterus.  As a consequence, the endometrium can no longer respond to hormone stimulation.  With this procedure, most patients experience approximately 70%-80 % reduction in menstrual flow.  A small percentage have no menstrual bleeding at all after therapy.  Endometrial ablation is reserved for patients who have completed childbearing.  Similar to the IUD, the procedure can be performed in the office.  Patients typically have a 72-hour weekend recovery time and are back to their activity levels thereafter.

Hysterectomy can sometimes be the best option for some women.  The good news is that “this isn’t your mother’s hysterectomy” anymore.  Various minimally invasive procedures are now available that afford much less discomfort and downtime.  Frequently, hysterectomy can be performed vaginally, especially in women who have experienced childbirth.  Cesarean deliveries do not preclude the ability to perform these procedures vaginally.  Often with the help of laparoscopic assistance, scar tissue can be taken down to facilitate a vaginal procedure.  The benefits of vaginal surgery include less recovery time and significantly less pain.   

The newest “darling” in hysterectomy treatment is the laparoscopic supracervical hysterectomy.  With small incisions, the uterus can be removed completely using a laparoscope.  Some experts believe that leaving a portion of the cervix in place contributes to pelvic floor support and sexual function.  We have performed several of these procedures at the Pearl Women’s Center in the Pearl District, which is set up to facilitate the laparoscopic supracervical hysterectomy as an outpatient procedure.

If you are suffering with heavy periods, call to set up a consultation.  “Go with the flow” may take on a whole new meaning for you.