Many women are affected by heavy menstrual flow which can affect their work and usual daily living. When you have to take time away from work or from your usual daily activities it may be time for an evaluation.
There are many potential causes for heavy bleeding, including obesity, hormonal imbalance, uterine fibroids and polyps and inherited bleeding disorders. Sometimes regular use of aspirin or other anti-inflammatory medications can contribute to heavy menstrual flow as well.
The place to start is with an evaluation, which includes an examination and some blood work. Usually we will recommend a pelvic ultrasound to exclude abnormalities of the uterus, including fibroids. We also usually consider a simple office procedure called “hysteroscopy” which involves sliding a narrow flexible scope through your cervix and up into your uterus to visualize the inside of your uterus. This helps us to identify polyps, fibroids (some are small enough to be missed on ultrasound but large enough to contribute to bleeding problems) and also to exclude uterine cancer or hyperplasia.
Once we determine that there is no specific reason for the bleeding that can be corrected we will usually recommend that you consider one of several options.
Tranexamic acid is a prescription medication (Lysteda) that can be taken during the first 3 days of your menstrual cycle to reduce blood flow. It is generally very effective. It cannot be taken by patients that have a history of blood clots.
A Mirena IUD is often very helpful in reducing or eliminating menstrual flow, while at the same time providing an excellent method of contraception. This IUD can be left in place for 5 years.
Birth control pills will often reduce menstrual blood flow.
Endometrial ablation is a procedure that can be performed with either local or general anesthesia that burns the lining of your uterus in order to reduce or eliminate menstrual flow. The procedure has a 10% failure rate, but 90% of patients are happy that their flow is significantly reduced or has stopped after the procedure.
Finally, hysterectomy is reserved for the most severe cases and in patients would have either failed or who have a contraindication to the other alternatives.
As always, the best place to start is with a visit to your doctor to discuss options that may be suitable for you.