Heavy Periods?

protectionSo—are your periods looking like a murder scene from DEXTER?

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Enough that they last up to a week, but worrying about gushing through to your clothes—-PLEASE!!!

Have you sat, and screamed at ads showing skinny models pouring a THIMBLEFUL of blue liquid onto a maxi pad with wings?   Those wings are nothing more than postage stamps when it comes to heavy periods!  Hey—girl!!   Chuck a cupful of that blue dye on that pad–fast!   What??  It splashed over the edge onto that white dress you are wearing?  Like anyone with heavy periods would even wear a white pair of pants!!!

So—if your period lasts longer than 7 days, or you are carrying grocery bags with a change of underwear or clothes, or you are arranging towels on your bed–you may want to do something about that!

Of course, you could just “bleed on”—take extra iron, and wear the extra bulky night-time pads all day—or—-you could see your doctor.

Now, despite what your friends may tell you–hysterectomy is not the FIRST thing to try!   I love it when women come in and say–“Sweetie—I’m done having kids, I’m over having periods, and I JUST want a hysterectomy!”   JUST?????????

If there is ONE thing that we need to learn from the death of Joan Rivers—there is no such thing as routine surgical procedures—they all carry risk.

click here to see RISKS OF HYSTERECTOMY–MAYO CLINIC

Hysterectomy really should be for those women that have tried to treat this problem medically, but it didn’t work!

So–what are your options?

Well, I do like to see that a recent (last year), thyroid test has been done and, if the bleeding is heavy, that a blood count is done, to see if you need iron pills–or even a transfusion.

Few questions–like could this be a miscarriage?  Are you on steroids, or blood thinners?

If these are OK, then it comes to an exam–how big is that uterus?

Do you have fibroids?  What are they?

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They are growths that are found in  about 25 % of women over the age of 40–and it is VERY VERY rare for these to be cancerous.   Usually, fibroids are no problem at all!  We quietly go about our lives–totally unaware that there may be a fibroid on our uterus–nothing to worry about at all!

When fibroids cause problems, the main problem is heavier periods!   Usually this can be handled medically.  Surgery is an option for a uterus with a ‘boatload’ of fibroids, or for a fibroid that doesn’t respond to medical therapy.

Also, as a general rule, FIBROIDS DO NOT HURT!  If you have pelvic pain, and a few small fibroids, you need to find another reason for PAIN!   Fibroids MAY hurt if their blood supply is cut off, or if you have one hanging off the uterus that gets twisted–this is uncommon.

Now–if we see that your thyroid is normal, and the ultrasound doesn’t show any ginormous fibroid, or other abnormality then you have what I call ” STUPID UTERUS SYNDROME”.  Just a term I use—not medically correct (I’m supposed to say “dysfunctional uterine bleeding”–like who the heck understands that)??

The uterus is the only organ in your body that doesn’t have to be cut to bleed!!  Anyway—I think most of us would say, at this point  –“That stupid uterus!!!!!!”

MEDICAL THERAPY OPTIONS

If you are eligible—then birth control pills are a good option–and you don’t have to have a period every month on the pill—you can just keep taking the real (active) pills on a long-term basis.

You can use the pill up to age 50 ( and we often go to 53-54–just to get you through menopause), if you don’t smoke.

You shouldn’t use pill if you are over 35 and smoke, have had blood clots in your legs or lungs, heart attack or stroke in the past, liver failure…

If you cannot use estrogen, then there are progesterone- only pills that you can take every day, and try to stop your periods.

There is the Mirena IUD—a lovely option-in my opinion.  It is used by MILLIONS of women around the world.  The risks are VERY low–and I do not consider cramps, or continued bleeding with the Mirena as a “horror story”.  In 30 years, I know of one perforation–which required a day surgery laparoscopy to remove–with no complications-in a patient that I put the IUD in.   I know of a couple of others in other surrounding hospitals–but we put in hundreds of these every year!  NOTHING is side effect free.   Over 90% of women love their Mirena!!

People come in and say, “I read on the internet that it moved, or it went into the abdomen”—NO WAY am I having that put in me.

Again, I will say, the risks are LOW!!   If you DRIVE in a car down a country lane at 70 km/hr and cars are hurtling toward you in the opposite lane at 70 km/hr–you are seperated by only what?— 3-4 feet?   I know of WAY more deaths due to car wrecks —hundreds of people being killed EVERY DAY!!!—Yet–you get in, and turn that key.

There are risks to childbirth—look at the TV series–CALL THE MIDWIFE!  There are risks to bleeding—blood transfusion, passing out and knocking yourself out, heart attack from blood loss—I could go on–but you surely get the point.

It is a pretty straight-forward OFFICE procedure–preferably put in WHILE you are on your period.   (See post on Birth Control)

DEPO-PROVERA

This is the three month contraceptive shot—and it can be effective at reducing, or eliminating periods.  Side effect can be irregular bleeding for the first few weeks (we could have you use Cyklokapron -see below- to stop that), and we cannot predict who it will work for.  Many women love it.  Remember to take some extra calcium daily–it has been linked with bone loss–but hey, most of us don’t get enough calcium anway!

Other newer options:

CYKLOKAPRON (tranexamic acid)

If you don’t want to take pills every day–you can start these at the start of a period–3-4 times a day (discuss with your doctor)–it will typically reduce your bleeding by over 50%.  You typically take this medication until you stop bleeding for 24 hours, then you stop the med.  Most women don’t use more than 5 days.

This med is NOT a birth control!

This link shows information on tranexamic acid

This is a great drug to try and stop heavy bleeding–even if something further is planned.  I recommend it to the ER docs when someone comes to the ER with heavy bleeding.

NSAIDS

Yes–Aleve, Naproxen, Advil–they can help reduce your bleeding, if you start taking them a few days before your period starts–follow package insert.  Downside is –that old stomach can find this stuff irritating–but it’s a reasonable choice–and certainly taking it when your period starts can help!

FIBRISTAL

Love this drug too!  I am not overwhelmed with its ability to shrink fibroids–I just want the BLEEDING to stop!!!  As do you!!

It is a pretty nice option for women in their late 40s to early 50s–you take it for 12 weeks–during which time we hope you don’t bleed, then stop, and wait for a period.  If you have another period–you start again for another 3 months.  My hope is that you will soon go through natural menopause, and don’t have to use any drugs.

I will use it on women in their 30s, just to STOP bleeding–while we wait for ultrasound, and other tests to be done-and give the woman a three month break!  I will often give it with Cyklokapron (which you would take for a few days, then continue on with the Fibristal).

It does not drop your natural estrogen, so hot flashes- if you have them- should not be due to this drug–they may be due to ‘change of life’.

This is not a birth control!

Fibristal drug information

NOVASURE ABLATION

Surgical option–NOT A BIRTH CONTROL METHOD

It is an outpatient procedure where we go inside your uterus with a camera/light and look around for anything abnormal, do a scraping to send for analysis at the lab, and then use a special device to burn the lining of the uterus.

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The only part that is INSIDE you is the triangle shaped thing at the end.  It is like a metal stocking that goes inside, and uses electrical current to burn the lining of the uterus.   YOU ARE ASLEEP FOR THIS!

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When you burn the lining, the hope is that your periods will become MUCH MUCH lighter–and, in some cases, even stop.  WE DO NOT GUARANTEE no periods!

Done under anesthesia–but has been done in an office with sedation and a block.

THE DOCTORS have a good video here!

Done here without anesthesia–we do it in the OR

I think this is a good option if your periods heavy–but I do have some concerns about doing this on obese women.

I’ll explain:

Before menopause, your ovaries produce ESTROGEN, and then when you ovulate(the cyst on your ovary that ruptures each month), the second hormone–PROGESTERONE–is made.   IF the egg is not fertilized, then the ovary spot where the egg came from starts to die down, and the progesterone level drops, and you have your period—which is getting rid of the lining of your uterus that has been built up by the estrogen.

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As you age and go through menopause, the ovaries stop working.  You stop making estrogen in your ovaries, and you don’t ovulate any more, so no more progesterone.    BUT (there’s always a but), estrogen will continue to be made in any fat tissue you have.  Because you will no longer be ovulating, there will be no natural production of progesterone to get rid of the lining of the uterus that is built up by estrogen.  So the lining just keeps building up, and building up (every woman builds at differecnt rates),  and you never get rid of it!  The more fluffy you are, the higher the chance that you are making estrogen in the menopause.

This puts you at risk for cancer of the lining of the uterus.

If you come in with “post menopausal bleeding”–bleeding that occurs after one year of no periods,  it would be good to get a biopsy of the lining of the uterus.  This is sometimes not possible after an ablation, because the walls inside the uterus are stuck together.  This can be a problem—there is a 10% chance of cancer–and we can’t get the biopsy–so 90% chance you will get a surgery and it will NOT be cancer–and you would be high risk surgery if you now have diabetes (wound healing kinda sucks), and obesity(fat tissue doesn’t heal well either).

So–the very thing you wanted to avoid with the ablation–you end up getting down the road.

I would prefer the use of a Mirena for high risk women–it gives same results as an ablation–and gives progesterone to your uterus to protect you against the estrogen made by your fat tissue–and if you are not using it for contraception–you can leave in for longer than 5 years!  I would leave it in for TEN years.

Myomectomy

Some women choose to leave their uterus in their body, and have a troublesome fibroid removed.  Myomectomy is usually done if you want to save your uterus for childbearing—or have an objection to hysterectomy.

This is a pretty graphic operation on a large fibroid

WARNING——it shows the actual surgery!

UTERINE ARTERY EMBOLIZATION

This is a procedure done in the Xray department by an Interventional Radiologist.   Basically, a catheter in put into the artery in your groin–and threaded into the artery that supplies your uterus–then microscopic beads are injected to cut off the blood supply.

It is quite popular in the United States, and I have had some patients opt for this.  Most do well, but I have seen some pretty serious consequences, that required emergency hysterectomy–and ICU admission!  Once again–there is no such thing as risk-free procedures.

VIDEO SHOWING EMBOLIZATION

 

HYSTERECTOMY

Can be done in several ways:

1   through the vagina

2    laparoscopic

3    abdominal

hysterectomy

Now–gonna blow your mind.

Doctors, nurses, and public all use wrong terms for TOTAL and PARTIAL HYSTERECTOMY.

A TOTAL HYSTERECTOMY–as you can see above-is the removal of the ENTIRE UTERUS.

A PARTIAL HYSTERECTOMY–is removal of the upper part of the uterus )the part that is to blame for most of the bleeding)–but leaving the CERVIX left in.  Sometimes it is too difficult to get the cervix out, and sometimes women want it left in to keep support in place for the vagina–or have a personal preference to have it left in.  You have to keep going with pap smears in this case.

REMOVAL OF TUBES IS A SALPINGECTOMY

REMOVAL OF OVARIES IS OOPHORECTOMY

So–if you have your whole uterus and your tubes and both your ovaries removed -this would be a

HYSTERECTOMY AND BILATERAL (both) SALPINGO-OOPHORECTOMY.

It is NOT a “complete hysterectomy”

Removal of your whole uterus is a TOTAL HYSTERECTOMY–it is NOT a “partial hysterectomy”.  A “partial” would mean your cervix is left in.

You also CANNOT have a “partial hysterectomy” done through the vagina, because you have to cut out your cervix to get to the top part of your uterus.

MIND BLOWN!

mind blown

click here if you want to see a vaginal hysterectomy–warning–a bit gory!!

Hysterectomy is the end of the line!!

 

 

 

5 Replies to “Heavy Periods?”

  1. lenjerii pat says:

    even if there aren’t so many comments, this article is awesome

  2. Thank you so much for your information its very helpful.
    I am interested in hearing more about your comment regarding not being impressed by fibristal to shrink fibroids. I currently am contemplating taking it for that very reason. I have a graitfruit sized fibroid and supposedly a few other smaller ones. Im 47 and wont be having children. I have the mirena IUD and thus do not have a period. It was suggested to me to try and shrink the fibroids so I could have the hysterectomy removal via the vagina instead of through an incision in the abdomen. I think that smart but have not found any studies stating its useful in this area.
    I wonder about taking it to reduce my hormonal challenges as I suddenly feel a little more off than usual. What I mean is I feel emotional and similr to when I was a teenager, I think. I cry at cute babies and many things. Im okay with that but I seem little more impulsive, and have spoken up to friends about themselves and had it not go well as they felt my comments hurtful where I felt I was truly aiding them by being so honest….blah blah blah. If it doesnt shrink fibroids evah….would it be worth trying for other reasons and perhaps after 6 months do an ultra sound to see if their has been changes to those fibroids. Currently they want to do surgery and Im open to it but if I can have another option that would be less evasive I would like to try it.

    1. admin says:

      If the Mirena is working in that your periods are lighter and/ or manageable then you don’t have to remove a uterus because there is a fibroid on it at all. I, personally, had an 18 cm fibroid–it shrunk to 10 cm at menopause but the Mirena did just fine for me.

      The amount of shrinkage is very small and I tend to use CORING MORCELLATION if the uterus is coming out vaginally. OF course, there are other reasons to have a hysterectomy.
      With regards to hormones, there is no difference in the estrogen level with Fibristal.

  3. Holly Rafuse says:

    Love your site! Such a good resource and very informative. My only complaint is that I didn’t know about it sooner.

    1. admin says:

      Thanks Holly—you can tell your patients about the site—I tried to put it out in plain English–and hope to add quite a few posts over the fall and winter.

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