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A dreaded visit from 'Aunt Flo'

Management Options for Heavy Menstrual Bleeding

A day does not go by without talking to a patient about her heavy menstrual periods.  I am always amazed by how much women put up with in regards to their periods.  Simply put, if you have bleeding that causes you to miss a day at work, requires your husband to bring you a change of clothes or if you have bleeding that stains your clothes and/or bedding, then your periods are affecting your quality of life.  This type of bleeding does not need to be accepted or tolerated.  You actually can do something about it. Getting control over your periods, will without a doubt change your life.

In our mothers' and grandmothers' time, there were very few options.  Most women with heavy periods had hysterectomies.  Although there are minimally invasive options for hysterectomies that result in faster recovery then traditional abdominal hysterectomies, you now have other options.

In order to determine if you are a candidate for a certain option, you doctor will need to perform certain tests/studies.  These tests/studies may include the following: pelvic ultrasound, endometrial biopsy, sonohysterogram or hysteroscopy.  Which tests are performed depends on a number of factors, such as the woman's age, the description of the bleeding, risk factors for endometrial cancer and response to previous therapies.

A brief word about the sonohysterogram...The sonohysterogram is a great in office procedure that allows the gynecologist to evaluate the uterine cavity.  A small catheter is inserted into the patient's cervix.  A balloon is inflated that occludes the cervical opening.  Saline is then infused into the uterine cavity.  The uterine cavity then blows up like a small water balloon while transvaginal ultrasound images are viewed on a screen.  If a mass is within the uterine cavity, it will be seen.  

This YouTube video is a good example of a sonohysterogram: 

 

The procedure causes some cramping but most women tolerate it well.  If a mass is seen, a day surgery procedure called a hysteroscopy can be performed to remove the mass.  Intrauterine masses can be the cause of heavy menses.  Evaluation for the presence of these masses is often a necessary component of evaluation for heavy menses.

A non-hormonal procedure to treat heavy menses is an endometrial ablation.  An endometrial ablation procedure performed in my office is called the Novasure endometrial ablation.  If desired, this procedure can be performed under anesthesia in a hospital.  This procedure does not involve making any incisions on the abdomen.  It is a vaginal procedure.  The Novasure instrument is inserted into the uterine cavity and radiofrequency energy is applied to the lining of the uterus that burns the lining of the uterus.  This makes the cells of the endometrium inactive.  About 90% of women have the desired result of decreased bleeding during menses or complete cessation of menses (also known as amenorrhea).

I encourage you to visit Novasure.com for more information.  I do not have a special interest in the procedure.  I do not have a special arrangement with the company.  However, I believe in the procedure.  It is a viable option for busy women who desire treatment for their heavy periods, but also desire to return to their normal level of activity as quickly as possible.  Not all women are candidates for an ablation.  I encourage you to ask your doctor about the procedure and if it is the right choice for you.  It is also important to know that, if you choose this procedure, it is not a sterilization procedure. You will need a reliable form of contraception. 

So, if you find yourself dreading a visit from Aunt Flo, don't be discouraged.  You have options that have the potential to change your life.

The information in this blog should not take the place of advice from your physician. If you are interested in this procedure, ask your medical provider for more information.

 

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