Treatment Options for Heavy Menses

Medications

Ibuprofen or another prostaglandin inhibitor is often prescribed. Ibuprofen is also available in lower dosages (Advil, Nuprin) without prescription. Some prescription “cousins” of ibuprofen may decrease heavy flow, but may lengthen the time of bleeding.

Hormones

If the heavy bleeding is related to hormonal abnormalities, treatment of the specific abnormality will correct most bleeding. Female hormones (birth control pills or progestins) are commonly used to regulate menses. Most bleeding caused by hormone imbalance can be treated medically.

The Mirena® progesterone IUD may decrease bleeding. It can, however, cause irregular bleeding for the first 6 months.

Dilation & Curettage

In some cases of heavy bleeding, dilation and curettage (”D and C”) may be required. Dilation means enlarging and curettage means scraping. Together, this procedure involves expanding or enlarging the entrance of a woman’s uterus so that a thin, sharp instrument can scrape or suction away the lining of the uterus and take tissue samples.

The D&C procedure is routine and considered safe. It is minor surgery that is performed in a hospital, ambulatory surgery center or clinic. This is usually a diagnostic procedure and seldom considered therapeutic. It may stop bleeding for a short while (possibly 2-6 months) and then the prior abnormal bleeding will likely return.

A D&C is seldom done as a lone procedure anymore. It is most often done as an adjunct procedure to a hysteroscopy and/orpolypectomy.

Fibroid Removal

Fibroids and polyps are thought to occur in about 20% of all women are common and are not related to cancer. Fibroid tumors are noncancerous growths appearing in and around the uterus. Polyps, like fibroids, are noncancerous growths and are a common cause of chronic pain and irregular bleeding.

Fibroids may stop growing by themselves, and surgery may not be needed depending on the amount of bleeding, the location of the fibroid, and the response to various treatment attempts. Fibroids often stop growing at menopause, so an operation can be avoided by waiting. However, if there has been rapid growth of the fibroid tumor or if your Pap smear is abnormal, surgery or another type of therapy may be necessary.

If abnormal bleeding is caused by fibroids or polyps, often removing them will solve the problem. Sometimes an endometrial ablation is performed to further reduce or eliminate bleeding.

Endometrial Ablation

If no specific anatomical cause is identified or if hormonal disturbances do not improve with hormone therapy, endometrial ablation (destruction of the uterine lining) may be an alternative to having a hysterectomy. Endometrial ablation is a quick outpatient procedure, that will usually eliminate or greatly decrease menstrual bleeding depending on the cause. Endometrial ablation procedures can be accomplished through a variety of techniques. Read more on endometrial ablation here.

Hysterectomy

A Hysterectomy is the only procedure that guarantees permanent elimination of any bleeding. It usually makes sense to consider less invasive alternatives before having major surgery.

Fortunately, most heavy bleeding can now be easily treated without major surgery.

This information is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, or have any questions, please contact your obstetrician-gynecologist.