Treatment Options for Heavy Menstrual Periods, Menorrhagia

If you are noticing an increase in menstrual flow that is interfering with your work, causing low blood counts or soiling your clothes, it may be time to discuss the situation with your gynecologist.

Non-hormonal medications like non-steroidal anti-inflammatory drugs, or tranexamic acid can be prescribed to help with menstrual flow. These are usually taken just before or at the time of the menstrual flow, for a limited number of days.

Hormonal treatments with oral contraceptive pills or injectable progesterone can be used to decrease menstrual flow quite successfully, often with other benefits, such as decreased cramping and additional contraception. These treatments are generally taken continuously.

The Mirena IUD (levonorgestrel intrauterine system) is a treatment where a physician places a progesterone-secreting IUD within the uterine cavity, where the hormone works locally to thin the uterine lining and reduce menstrual flow. The IUD can stay in place for up to 5 years before needing replacement, and can reduce menstrual flow by about 90% after one year of use.

Endometrial ablation refers to a technique whereby the endometrial lining of the uterus (the part that bleeds) is scarred or partially destroyed by various techniques, such as freezing/hot water/radiofrequency electricity/microwave/laser/heated laser ball. Most gynecologists have experience with one or more of these methods of ablation and choose the type of ablation that would fit the patient based on familiarity/safety/convenience factors, as well as the specific shape/size of the patient’s uterus being treated. These procedures are usually outpatient or office procedures with some sedation or anesthesia needed.

If specific problems are found by the gynecologist, such as endometrial polyps or fibroids, sometimes these can be specifically addressed with a minimally invasive surgery to remove only the polyp or fibroid, depending on the location.

When child-bearing is complete, hysterectomy can be performed to treat menorrhagia that has been resistant to treatment by more conservative means, although general anesthesia is usually performed, along with a 2-6 week recovery period at home.