Health Column: Enough is enough ... an end to heavy menstrual bleeding

By Christian S. Pope, DO, FACOG
Diplomate, American Board of Obstetrics and Gynecology
HealthCare for Women Inc., New Bedford and Mattapoisett

Dr. Pope practices at St. Luke's Hospital, the New Bedford site of Southcoast Hospitals Group. He can be reached at 508-999-6245.

Dr. Pope is a featured columnist for The Standard-Times on women's health topics. Check out Dr. Pope's column the first Tuesday of every month at www.southcoasttoday.com.

Heavy menstrual bleeding or "menorrhagia" afflicts one in five women; that is approximately 10 million women in the U.S., including one-third of all baby boomers. Menorrhagia is a clinical term used in gynecology to describe menstrual periods that are heavy, prolonged or restrict a woman's quality of life. Patients who perceive that their periods are heavy can be offered various FDA-approved treatment options.

What are the physical & psychological consequences of menorrhagia?

Symptoms range from severe pain and cramping to fatigue, emotional turmoil and embarrassment. Regardless of your symptoms, heavy menses can be restrictive to lifestyle, social activities and may result in missed work time.

In a recent survey of women suffering from heavy periods, nearly 60 percent reported lack of confidence and 70 percent felt they could not perform effectively at work or other activities and often missed plans or athletic events. Eighty percent of women claimed that they experience anxiety surrounding their menstrual cycle. Four out of five women also report a negative impact on their sexual relationship. Additionally, menorrhagia is also a common cause of iron deficiency anemia. According to a recent survey conducted by the National Women's Health Resource Center, nearly 40 percent of women with menorrhagia developed anemia. Anemia is a common cause of fatigue and propensity to develop bladder infections and often requires treatment with iron replacement therapy.

What are the current treatment options?

Hormonal Therapy: Oral contraceptives are commonly used. For women who would like to keep their child-bearing options open, oral contraceptives may help alleviate heavy bleeding. However, research shows hormonal therapy is effective in reducing or eliminating heavy periods in less than 50 percent of cases. Side effects and potential risks of oral contraceptives need to be weighed against the success rate in improving symptoms.

Mirena Intrauterine Device: A non FDA-approved option for menorrhagia is a 5-year long acting contraceptive that is placed within the uterus during an office visit. It releases a hormone called progesterone locally within the uterus that over several months causes menses to lighten with as many as 25 percent of women experiencing no menses 12 months after its insertion. Side effects range from mild cramping to irregular bleeding for the first several months.

Endometrial Ablation: A highly successful outpatient procedure that permanently treats the uterine lining that causes menstrual bleeding. Because of its safety, high efficacy and minimal recovery time, the American College of Obstetricians and Gynecologists recommends that it be considered as a first-line treatment for women with problem periods caused by heavy menstrual bleeding who have completed child-bearing, bypassing the potentially less successful option of hormonal therapy.

Endometrial ablation is an outpatient procedure that takes just a few minutes and requires no general anesthesia, no abdominal incisions, minimal recovery time and return to normal activities the day following the procedure. Results demonstrate that nearly 80 percent of women achieved complete cessation of their periods, and 98 percent had a significant improvement in the amount of menstrual bleeding. Studies have consistently demonstrated improved quality of life, reduced PMS symptoms as well as menstrual related cramping after endometrial ablation has been performed.

Two types of endometrial ablation with the highest success rates are Novasure® and Thermachoice® endometrial ablations. You may learn about these procedures from discussion with your gynecologist and related websites at www.novasure.com, www.gynecare.com/thermachoice and www.southcoast.org/women/.

Hysterectomy: Approximately 600,0000 hysterectomies are performed in the U.S. each year. The most common reasons leading to the procedure are excessive menstrual bleeding, uterine fibroids and uterine cancer. A hysterectomy is the surgical removal of the uterus. Some women also warrant removal of the cervix and/or ovaries for reasons unrelated to their bleeding concerns. It is important to note that just because you're having a hysterectomy, does not mean that you are having your ovaries removed, which would mean no change in your daily hormone levels. Hysterectomy equals no more periods, not menopause.

Curiously, most hysterectomies in the U.S. are still being performed through a six inch incision in the lower abdomen. In the Southcoast, gynecologists are performing most hysterectomies laparoscopically, that is, through three tiny one to two centimeter incisions in the abdomen. This allows for only one overnight hospital stay, less blood loss at surgery, lower infection risk, less postoperative pain, much faster recovery time of about two weeks with a better cosmetic outcome on the skin.

In the upcoming year, the newest innovation may likely be entering our area with hysterectomies being performed through a single two cm incision hidden in the navel area. Again, all the benefits of a minimally invasive approach to a hysterectomy.

Heavy menstrual bleeding is a potentially serious and restricting medical condition that forces sufferers to make lifestyle changes. Women dealing from menorrhagia now have a variety of highly successful treatment options available to them which can greatly improve their quality of life.