Heavy menstrual bleeding (HMB) can impact up to 25% of women, so it's a common problem that we see in the Women's Wellness Clinic. When women come in to our office seeking relief from heavy periods, we need to ask two questions:
Why is this patient having heavy periods?
Which treatment options will improve this patient's bleeding problem?
First off, it's hard to exactly define heavy periods--after all, how heavy is too heavy? My benchmark for heavy periods is the effect of the periods on a woman's quality of life. Is she missing work? Staying home from social activities on her heaviest days? Changing bed sheets in the middle of the night because of leaks? Feeling too tired to exercise during her cycle?
Step one of investigating heavy periods will often be a combination of blood tests and an ultrasound. Blood tests can check for anemia, hormone imbalances like thyroid problems, bleeding disorders, and the like. An ultrasound can look for problems such as fibroids (benign tumors in the uterus that occur in anywhere from 40-80% of women, depending on ethnicity).
Step two will be discussing treatment options, which often depends on the results of the investigation in step one. If there is an obvious problem--such as thyroid disease or a large fibroid--usually the treatment is fixing that problem. However, many women with heavy periods do not have a specific, actionable problem. But that doesn't mean that we can't improve the heavy periods! I usually break down treatment options into Low Commitment, Medium Commitment, and Higher Commitment. (Clearly, these are not divisions based on anything I learned in medical school--I just find it helpful to categorize treatments in this fashion when discussing them with patients.)
Low commitment options are typically lifestyle changes and medicines. Treatment choices might include:
Routine exercise, yoga, ibuprofen (which relieves cramps but also decreases flow a little), magnesium supplementation
Hormonal contraception such as birth control pills, patches or rings can reduce bleeding by about 40%
Depo Provera shots will stop periods in about 70% of women
Tranexamic acid (brand name Lysteda) is a nonhormonal oral pill taken only on heavy flow days which can reduce bleeding by about 50%
The primary medium commitment option would be a hormonal intrauterine device (IUD) like Mirena, which is FDA-approved for the treatment of heavy menstrual bleeding and can reduce blood flow by up to 80%. An IUD is placed during an office visit, so it's not a surgery, but it is a little more involved than simply popping a pill.
Higher commitment options usually include procedures or surgery. These choices can include endometrial ablation (cauterizing the lining of the uterus), uterine artery embolization (injecting tiny particles to clot off the blood vessels supplying the uterus), or even hysterectomy. These are not typically the first options that patients choose, but they are still options nonetheless.
Discussion of these treatment options will include a review of pros, cons, potential side effects, and which option(s) might be most appropriate for a particular woman with a particular medical history.
If you are having heavy periods and seeking relief, schedule an appointment with us today so we can go over your personalized options.