Heavy, irregular bleeding is one of the most frequent reasons a patient will come into see a gynecologist, affecting 1 out of 5 women. As a gynecologist, I am here to help, so do not feel embarrassed to bring this or any other problem up at your visit. It is common for patients to present to the office describing their menses as having large clots for 3-4 days of their cycle, and lasting more than 7 days.

 

For many women they consider this normal, as they will say, “my periods have always been like that,” or “they have been like this since my last child was born.” In other situations, patients will become so fatigued during their cycle they are unable to work. Sometimes they are referred by a hospital after requiring a blood transfusion. I am amazed the inconveniences women are willing to go through to avoid seeing a gynecologist, often due to the fear that a hysterectomy will be presented as their only solution.

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Patients have shared disheartening stories of bleeding through a tampon, Maxi pad and then their clothes at work, requiring them to wear dark clothes or just call in sick. Their cycles can keep them from exercising, ruin bed sheets, prevent going to social events, engaging in sex or just make them a shut-in during that time of the month.

Often associated with the bleeding are symptoms mimicking Premenstrual Syndrome (PMS), a disorder that is usually hormone related. Moodiness, decreased self-confidence, lack of energy, and headaches are typical side effects with heavy periods. A strained relationship with their partner, is common, due to the constant need to avoid intercourse from the bleeding and the fear that bleeding will start at any time. Most women are not going to feel very sexy and often complain of decreased sex drive as a result. It is not until a patient sits down in my office and talks to me that they may realize they are in a constant state of anxiety and fear due to their bleeding. Many women have been placed on anti-depressant/anxiety medication by their primary care provider, instead of trying to determine the etiology of their psychological issues. In many instances, women I have treated for heavy bleeding have had complete resolution of the symptoms described above. In follow-up visits women tell me they have returned to a ‘normal life’, ‘feel better than they have in years’, express that home and work life are greatly improved and that they are off their medications. When they come in your office it is like meeting an entirely new person, this is extremely gratifying as a physician.

In the past, heavy vaginal bleeding, referred to as menorrhagia, by gynecologists was defined as a cycle greater than 7 days and/or more than 80 ml of blood loss. To put things in perspective a can of soda has 355 ml of fluid, frequently when I tell this to patients I get the response, ‘I bleed that much every month, I thought that was normal’. Currently a more common sense approach is used to make the diagnosis. If you have bleeding that significantly alters your normal activities of daily living (ADL) or you perceive the bleeding as heavy, you should seek the advice of a women’s health specialist.

When women present this problem to me I take into consideration a number of factors, desire to have future children, previous medical management, age, along with radiologic, laboratory and physical exam findings. We have come a long way from only being able to offer birth control pills, anti-inflammatories (Advil and Aleve), or a hysterectomy (which permanently eliminates the problem).

Non-surgical options have expanded to include the Mirena Intrauterine Device, Nexplanon and a non-hormonal medication, Lysteda, which when taken with the onset of your cycle will usually cut your bleeding down by at least half. I have heard its praises repeatedly from my patients, best of all it has none of the potential hormone related side effects and is relatively inexpensive.

The endometrium is the lining of the uterus where your menses come from. For women done with child bearing an in-office procedure called Endometrial Ablation has been a godsend. Not only has it kept many of my patients from needing major surgery, it frequently costs the patient an office copayment to perform. In addition, you will be in our office for less than an hour, it will be painless, and you will not remember having the procedure, as an anesthesiologist will be providing you short acting intravenous sedation. Most women return to work the following day. It almost sounds too good to be true. Instead of removing your uterus we simply destroy the endometrium, or lining of the uterus, thus eliminating the origin of your bleeding. There are no incisions, no preoperative treatments, and very little risk of complication.

Most patients should expect a significant reduction of menstrual flow and for 41% no more periods at all. Please be assured that despite what your mom or grandmother may have told you, not having a menstrual period after an ablation is very safe and has no effect on your hormones. Endometrial Ablation has been shown to lessen menstrual cramps in many, but should not be considered a primary treatment for this condition. In addition, patients report increased energy levels, better mood, increased self-confidence and a marked reduction in premenstrual symptoms.

In the United States, there are five devices approved by the FDA for Endometrial Ablation, all with similar reports of patient satisfaction and decreased bleeding rates. Be sure to find out which device your doctor is using because they are not all the same.

Four of the devices in use require either pretreatment with a medication called Lupron, which makes the patient menopausal for a month or a pre-procedure Dilation & Curettage (D&C) to get their results. Only Novasure requires no pretreatment and can be performed at any time of the month. All use either freezing or high temperature to eliminate the lining of the uterus. Only two devices have been shown to eliminate 3 cm or smaller fibroids or polyps inside the endometrial cavity, a common cause of heavy bleeding, those two are Novasure and Thermachoice. From all devices, you can expect a watery brown discharge for about a month following the procedure.

One device, the Hydro ThermAblator is just plain dangerous, it places 90 degree Celsius fluid directly into the uterus and if it leaks out of the uterus can cause 3 rd degree burns in the vagina. You may wonder why this device is still on the market. Like too many procedures done in the United States complications are frequently never reported or are underestimated. If I personally have met two patients in the last 2 years who have had this complication you can imagine how many actually have had it. Unfortunately you will find physicians stuck in their ways, unwilling to learn newer safer ways of doing things or often they have a financial investment in the machine they use; as a result they are providing a grave disservice to their patients.

Two devices, Her Option (freezing method) and MEA (microwave method) are very operator dependent. To get good results, both require continuous precise movements and the first requires continuous ultrasound view during the procedure. I have seen the Her Option in action on several occasions it is what some would call a ‘crap shoot’ as to whether it will produce a good result.

Only one device, Novasure has a microprocessor and adjustable device settings to take into account the thickness of the endometrial lining, amount of blood in the uterus at the time of the procedure and the size of the uterus. Novasure is used for almost 70% of all ablations performed in the United States. Novasure uses carbon dioxide to ensure there are no holes in the uterus from placement, prior to allowing any energy to be released. This is a reassuring safety mechanism for the physician operator. In addition, the Novasure procedure takes only 30 to 90 seconds to perform while most other devices can take anywhere from 8 to 18 minutes.

It must be noted that endometrial ablations can only be performed in a uterus whose cavity measures 10 cm or less in length, a measurement your doctor can perform, and that ablation is not a form of birth control. Some form of permanent sterilization by you or your partner must in place; otherwise you risk having recurrent miscarriages or worse yet a pregnancy that implants into the muscle of the uterus.

In our office we perform Essure, hysteroscopic permanent sterilization, and then 3 months later Novasure ablation if no prior sterilization procedure is in place. Check our website for more information on Essure. On rare occasions, a uterine cavity can be too small for the Novasure device; in this situation I use the Thermachoice water balloon, which is an inflatable balloon that generates a temperature of 87 degrees Celsius. Its only drawback is that the device does not take into account that every uterus is different and will require a different amount of energy exposure to get optimal results.

If you have any questions about endometrial ablation, or any of the other methods mentioned to stop your heavy bleeding please do not hesitate to come in for a consultation, we have brochures with additional information about your options. The endometrial ablation is a great way to avoid a hysterectomy so I choose to use the device that I believe gives you the best chance of success. Take back control of your life consider Novasure for heavy periods.

Please note I have no financial ties to any medical device or company. All recommendations I make are based purely on my own research and experiences.

Suffering from heavy periods? Get the answers you need about Novasure and Abnormal Menstrual Bleeding

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