There's Nothing Normal About Abnormal Bleeding

A monthly menstrual cycle is a normal part of life for most women prior to menopause. Yet for one in five women, their period is abnormally heavy and troublesome. Some find themselves frequently rushing to the bathroom and constantly worrying about leaks and stains. Other women experience bleeding between periods or complain of periods lasting longer than the typical 5-7 days.

“I was afraid of going out and doing anything because I needed to be near a bathroom in case I had an accident,” recalls Karen Hoffer, who experienced abnormal bleeding. “I’m so busy that at first I didn’t notice how long the bleeding was continuing. I just thought as soon as it stopped, I would go for my annual Pap examination.”

Tammy Sauder also found her periods were interfering with her daily activities. “I never knew when I would get my period and when I did get it there would be excessive bleeding. I dreaded going away because of it,” she says.

Karen eventually sought help from her doctor, Thomas Fromuth, M.D., OB-GYN of Lancaster. Likewise, Tammy discussed her concerns with her doctor, Kathleen Gerbert, M.D., Doctors May-Grant Associates.

“Excessive menstrual bleeding can interfere with a woman’s quality of life, her relationships, work and her family. Many women suffer needlessly because they have heard that this is normal as they get older. While some changes can take place, that’s not always the case. It never hurts to check with your doctor to be sure,” says Dr. Fromuth. “Treating irregular or heavy bleeding can help a woman regain control of her life, rather than allowing the bleeding to control her.”

Normally, a woman’s menstrual cycle lasts about 28 days, with menstruation occurring for 5-7 days. Each month, a woman’s endometrium (lining of the uterus) prepares to sustain a baby. Increased hormonal levels help thicken the endometrium. When pregnancy does not occur, the body sheds the endometrium through a woman’s menstrual flow.

To determine the appropriate treatment, a woman’s doctor will perform a series of diagnostic tests. The cause can influence the preferred treatment. Women with fibroids, polyps or cancer benefit from a different course of treatment than women with hormonal imbalances or other conditions. Irregular or heavy bleeding can be caused by a variety of factors.

Some of the most common causes include:

• Hormonal imbalance
• Noncancerous uterine growths (polyps and fibroids)
• Neoplasia (new tissue growth)
• Blood clotting disorders
• Certain medications

Dr. Gerbert says that she considers a woman’s health history and lifestyle when recommending a treatment. “Some women have high risk factors associated with taking birth control pills or other medications,” she explains. “And endometrial ablation (surgical removal of the endometrium) is never to be used by anyone considering childbearing in the future. Also, women with irregular bleeding patterns may find that while endometrial ablation slows the bleeding, it does not change their hormonal cycle.”

• Medical therapy
• Hormonal manipulation (such as low-dosage birth control pills)
• IUD with progesterone (hormone)
• Endometrial ablation (surgical removal of the uterus lining)
• Hysterectomy

For Tammy, Dr. Gerbert recommended treatment with a birth control pill. The results have been dramatic. “Now I only have four or five days of light flow and before I would have 7-8 days of heavy flow,” Tammy says.

In Karen’s case, she and Dr. Fromuth decided the NovaSure™ technique of endometrial ablation was the best option. Six months later, Karen says the treatment was a success. “It’s given me complete and total freedom,” Karen reports.

NovaSure is a newer type of endometrial ablation and is not the answer for all women. However, Dr. Fromuth says that among the women who have had NovaSure, 40 percent have no bleeding and 50 percent experience reduced bleeding.

When performing NovaSure, the doctor inserts a triangular gold mesh device into a woman’s uterus. The mesh conforms to the shape of the uterus lining. A controlled electrical current heats the inside of the uterus. The entire procedure takes about 10-15 minutes and involves local anesthesia with mild sedation or general anesthesia. Women can return home the same day and find they only need to modify their activity level for a few days.

A similar variety of endometrial ablation called Thermachoice® uses a soft, flexible balloon that is inserted into the uterus. The balloon is filled with fluid and inflates to the size and shape of the uterus. The fluid is then heated and, in turn, heats the inside of the uterus. This procedure is also performed on an outpatient basis, with minimal anesthesia.

Both NovaSure and Thermachoice have similar success rates and neither involves an incision. Women undergoing these outpatient procedures may experience some mild cramping afterwards, but usually are able to return to work and their normal activities within a few days. Risks include infection, bleeding or perforation of the uterus.

These two treatments are the newest variations of a technique that has been around for several years. Another treatment option, a hysterectomy, involves a surgical incision and complete removal of the uterus. A hysterectomy requires an inpatient stay (2-3 days), a longer recovery time and greater risk for complications and infection.

“There used to be a lot of concern about hysterectomies being overused,” Dr. Gerbert says. “However, by the time I’m willing to consider performing a hysterectomy, I’ve tried other options. My patients are usually ready because they’re tired of the bleeding and the problems associated with it.”