Cindy M. Basinski, MD, FACOG - Gynecology: Heavy Bleeding

Cindy Basinski, MD, FACOG - Board Certified OB/GYN

Heavy Bleeding

Do you have heavy periods? Do you change your pad or tampon more often than every 2 hours? Here are your options:

Hormones/IUD

The simplest treatment is the use of hormones such as birth control pills or progesterone pills. However, many women are unable to use this option due to side effects or other medical conditions that inhibit hormonal use as well as some women do not want to take a birth control pill

Another option is the use of an intrauterine device called Mirena. The Mirena is used to either prevent pregnancy or treat heavy bleeding. The device has a small amount of progesterone within its T-shaped structure and is placed at the fundus, or top of the uterus, in a short office visit. This progesterone does circulate throughout your body and affects the lining of the uterus to thin it down and eliminate periods. Some women may experience hormonal side effects from this IUD. It is very safe and you can become pregnant within 1 month of its removal. I do tell patients that the Mirena device prevents pregnancy in many ways, but it does prevent implantation of a fertilized egg. You must be agreeable to this before I will place the device for you.

Endometrial Ablation

Endometrial Ablation is a procedure that can be performed either in the operating room or, less expensively, in the office. Both are performed in the same manner. This procedure is used to treat heavy bleeding. After the procedure, 90-95% of women will be satisfied with the results. Approximately 60-70% will no longer have any more periods or bleeding. Another 20-30% will have very light periods in which they bleed very lightly, only using a pantiliner throughout the period. Approximately 10% will fail the procedure and choose to manage bleeding as they have been doing, use hormones to control bleeding or opt for other surgical treatments such as hysterectomy.

If you fail any ablation procedure, you cannot repeat the procedure at a later time. It is also very important to understand that you should not become pregnant after this procedure. I encourage you to have a sterilization procedure in conjunction with an ablation. An ablation is not meant to prevent pregnancy.

Hysterectomy with or without ovaries

A hysterectomy is the removal of the uterus and cervix but not necessarily the removal of the ovaries. Laparoscopic Assisted Vaginal Hysterectomy (LAVH) is the most common way that I choose to remove a patient's uterus and cervix. This surgery usually takes 45-60 minutes to perform and you would stay in the hospital for 10-23 hours.

After a hysterectomy, you may never require another pap smear in the future, as long as you have never had a history of abnormal pap smears. The case for keeping the ovaries is that hormones produced by the ovaries help keep bones strong, prevent heart disease, and prevent menopausal symptoms. However, if a women keeps her ovaries, there is a risk for ovarian cancer or ovarian diseases that may require surgery in the future. Some reasons for removing the ovaries are endometriosis, family history of ovarian cancer, pain associated with recurrent ovarian cysts, ovarian tumors, hormonal or menstrual migraines or post-menopausal or near menopausal women.

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