DEAR DOCTOR K:
I bleed very heavily during my menstrual periods. Is there anything that can be done about this? Or do I just have to put up with the discomfort and inconvenience every month?
Excessive menstrual bleeding (the medical term is menorrhagia) is a common problem. In my experience, a few primary-care doctors tell their patients just to “live with it.” Not surprisingly, obstetrician/gynecologists are more likely to recognize excessive menstrual bleeding as a problem that needs treatment.
Many women take medication or hormones or have surgery for this problem. But a recent study suggests that an implantable device may also be able to help control excessive menstrual bleeding.
“Excessive blood flow” can be tricky to define since actual measurement is difficult. Your menstrual bleeding might be excessive if you:
- Have to change a pad every hour for at least three hours;
- Have to get up during the night to change a pad;
- Pass large clots;
- Develop anemia from blood loss.
It’s also important to consider the impact of heavy menstrual bleeding on your life. You may have menorrhagia if heavy bleeding impairs your social, physical or emotional life.
Current treatment options include taking hormones to help regulate bleeding. Medications are also available. One drug encourages blood to clot; another blocks production of a substance involved in menstrual bleeding. Another option is surgery to remove the lining of the uterus or the uterus itself (hysterectomy). Many women try multiple treatments in search of one that works.
A recent study compared existing treatments to a new approach. The study included nearly 600 women with menorrhagia. The women were randomly divided into two groups. One group received standard treatments with hormones or medicines. The other group received an intrauterine device (IUD) that releases a hormone inside the uterus. The IUD, sold under the brand name Mirena, is a type of birth control. Many women using the hormonal IUD for birth control have found that it reduces menstrual bleeding.
The study found that women assigned to treatment with the IUD:
- Had a significant reduction in symptoms over six months.
- Reported a bigger reduction in symptoms than those in the usual treatment group.
- Continued to have improved symptoms for at least two years.
- Reported improvements in:
*social and family life
*work and daily routine
*psychological and physical health
One study, even a large and carefully conducted study like this one, rarely changes practice overnight. But I’m cautiously optimistic that this new approach — hormonal IUDs — could become a new treatment option to improve the lives of women with menorrhagia.
CORRECTION: In a recent column on three new types of blood-thinning drugs that are alternatives to the long-available drug warfarin, I stated that the drugs needed to be taken twice a day. In fact, one of them, rivaroxaban (Xarelto), needs to be taken just once a day. I regret the error.