Treatment Options for Heavy Bleeding and Cramps
Do you have heavy, prolonged, irregular, or painful periods?
There are many options for treatment, and Dr. Basinski and Dr. Juran are committed to educating their patients on all available treatment modalities and empowering their patients to make an informed decision. Not all patients may be eligible for all treatment options depending on their personal medical histories.
The use of hormones such as birth control pills, progesterone pills, or progesterone injection can make periods lighter, more predictable, and less painful for some patients. However, many women are unable or do not desire to use this option due to side effects, risks associated with hormones, or other medical conditions that inhibit hormone use. Most of the time, such hormone use will also prevent pregnancy.
Another option is the use of an intrauterine device called Mirena. The Mirena is a plastic T-shaped device used to prevent pregnancy and can also treat heavy bleeding or cramps. The device has a small amount of progesterone within the plastic and is placed at the fundus, or top of the uterus, in a short office visit. The effect of the progesterone is to thin the lining of the uterus and prevent bleeding and cramps. The hormone does circulate throughout your body and some women may experience hormonal side effects. It is very safe and your ability to become pregnant returns within weeks of its removal. The Mirena IUD works in a variety of ways to prevent pregnancy, and one proposed, though unproven, mechanism of action is by preventing implantation of a fertilized egg. This must be agreeable to the patient prior to placement.
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 pantyliner 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. Ablation treats heavy periods but is not intended to prevent pregnancy. Because pregnancy after ablation can be high risk to mother and fetus, we do recommend a sterilization procedure prior to ablation. A popular choice is Essure, which is an in-office permanent sterilization method that can be performed prior to ablation.
Hysterectomy with or without removal of ovaries
A hysterectomy is the removal of the uterus and cervix but not necessarily the removal of the ovaries. Laparoscopic Assisted Vaginal Hysterectomy (LAVH) or Total Laparoscopic Hysterectomy (TLH) are the most common ways we 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. A hysterectomy is 100% effective treatment to stop heavy periods and menstrual cramps. 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. Pregnancy is not possible after a hysterectomy. For more details about hysterectomy and recovery, please see the hysterectomy page. A hysterectomy where the cervix is left in place may be an option in certain cases if the patient desires, with adequate counseling from your doctor.
Does a hysterectomy immediately put me into menopause?
Removing your uterus does not immediately put you into menopause. Menopause is a natural cluster of symptoms (hot flashes, mood swings, vaginal dryness, decreased libido) associated with a decrease in female hormones. These hormones are produced by the ovaries, not the uterus. All women go through menopause, regardless of hysterectomy. The average age of menopause is 51. While a hysterectomy will stop your periods, it does not cause immediate menopause unless you opt to have both ovaries removed at the time of hysterectomy. The case for keeping the ovaries is that hormones produced by the ovaries help keep bones strong, prevent heart disease, prevent menopausal symptoms, and increase quality of life. 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 breast or ovarian cancer, pain associated with recurrent ovarian cysts, ovarian tumors, PMS, or other hormonal symptoms. Hormone replacement therapy may be an option for women who have their ovaries removed. Whether or not to remove one or both ovaries at the time of your hysterectomy is an individualized decision each patient makes with her physician.