Many women suffer every month with heavy or long periods. Some women have had long or heavy periods for as far back as they can remember, while other women had regular clockwork periods without any problems for decades but over time they became increasingly heavy or prolonged. Heavy or prolonged menstrual bleeding is one of the most common complaints I hear in my gynecology practice. Luckily, in this day and age we have many options to offer women to decrease or even stop their periods. This is a brief summary of some of the most common and popular options.
What causes heavy periods?
The first step in treating heavy periods is to consider the possible causes. Heavy periods may be the result of hormonal dysregulation, or benign growths in the uterus such as endometrial polyps or fibroids. Rarely heavy and/or irregular uterine bleeding is due to precancerous changes or even uterine cancer. If a patient’s history is concerning, pelvic ultrasound, office endometrial biopsy, or hysteroscopy with dilation and curettage (D&C) can be used to diagnose and sometimes treat the underlying cause. If caught at an early stage atypical endometrial hyperplasia and even endometrial carcinoma is often treatable with hysterectomy and/or medical treatment.
Most birth control pills can be used in a continuous dose fashion (in which you take active pills for 3 months followed by a one week break for a period). Newer very low dose pills with only 2 hormone free days per month can also help to achieve dramatically lighter menstrual bleeding and a smaller percentage of patients may even skip multiple periods a year.
The Mirena IUD is an excellent option for people with heavy periods who may still want the ability to become pregnant in the future. It is 99% effective for contraception but also reversible should a women desire to become pregnant. The Mirena IUD is small T shaped device made of soft flexible plastic designed to be placed inside the uterus and slowly release the hormone levonorgestrel over a period of up to 5 years. It can be placed in the office in less than 15 minutes. By 6 months on average women have menstrual blood loss decreased by 70-95 %, and a significant percentage of women achieve amenorrhea (when periods stop completely for 6 months or longer) or have only spotting after the first 6 months to a year. Bleeding may be irregular with a Mirena IUD, rather than a regular monthly period women may have irregular spotting or light bleeding that may come every month or only every few months. Overall decrease in bleeding is similar to endometrial ablation.
An endometrial ablation can be a good option for patients uncomfortable with taking hormones or who have contraindications to hormones and do not wish to have an implant such as an IUD. Endometrial ablation is only for patients who will not have any future pregnancies. Novasure endometrial ablation is designed to be able to be performed in the office for most patients. In office hysteroscopy is performed to allow the doctor to examine the intrauterine cavity and take photos as well as taking tissue biopsies if needed. Assuming all findings are normal, the novasure procedure immediately follows and is completed in a few more minutes. Patients can usually go home within an hour or two. Patients should expect bleeding and some cramping for 1-2 weeks after the procedure but should be able to work and go about most of their usual activities if desired. Over the next 12 weeks bleeding becomes lighter. Patient satisfaction rates with endometrial ablation are approximately 90% at 1 year and amenorrhea rates are >30% at 1 year and >45 % at 2-5 years.
The majority of patients will be able to achieve satisfactory control of their heavy periods without having to have major surgery, however sometimes hysterectomy is the best or only option. Depending on the size of the uterus and other factors hysterectomy may be performed vaginally (with no abdominal incisions), laparoscopically, or abdominally through a larger incision similar to the incisions used for c-sections. The vaginal approach is preferred when possible but each case is different. Patients who have vaginal or laparoscopic hysterectomies usually stay in the hospital for one night and go home the morning following surgery. While the most difficult part of the recovery is usually over by the end of the 2nd week, full recovery takes 6-8 weeks.
Patients should consider that even if they do not wish to seek treatment at this time, and feel they can continue to manage their long or heavy periods on their own, evaluation is still advised for excessive menstrual bleeding to determine the cause, ensure it is not a symptom of malignancy, and ensure that they are not becoming anemic from excessive blood loss. While these and other treatments are available and recommended, the risks and benefits of all medical treatments should be discussed and considered and continued observation is also an option once serious medical risks have been ruled out.
Marianna Law, MD, FACOG
Dr. Law is a partner at Wake Women’s Health, a division of Wake Internal Medicine Consultants, and one of the few gynecology only practices in Raleigh. She and her partners Rosemarie Newman, MD and Prashanti Aryal, MD manage the full spectrum of benign medical and surgical gynecologic problems. Dr. Law is available Monday through Friday and has same-day appointments available for urgent problems. Wake Women’s Health also offers in-office procedures.