Difficult menstrual periods?

Several new and effective options are available.
By Robert W. Yelverton, M.D.

Are you finished with having babies but not with your difficult menstrual periods?  If this your dilemma, with its monthly (or even more frequent) reminder, advances in minimally invasive surgery may be your answer and perhaps your alternative to daily hormonal therapy or hysterectomy.  Approximately one in five women suffer from regular but excessive menstrual flow (menorrhagia).  Many women consider this monthly ordeal to be their inevitable plight in life (Eve’s curse) but in reality, excessive menstrual flow, leaking through pads or tampons, with associated cramps or even anemia is not normal and can be treated or completely resolved in a number of ways.  Today, thanks to advances in minimally invasive surgery, your options for relief are even greater than ever before.  

Excessive menstrual flow can be treated in a number of ways.  After your health care provider has ruled out serious medical conditions such as uterine cancer, you have several options for treatment, some temporary and some permanent.   The options you may be offered are hormonal treatment, D&C, hysterectomy, or the relatively new kid on the block, endometrial ablation.

Hormonal Therapy

Hormonal drugs which contain estrogen and/or progestin, two female hormones, can make the endometrial lining of the uterus thinner, thus reducing blood flow as the lining sheds each month.  Various hormonal products available for treatment include birth control pills, progestogens, and even progestogen containing intrauterine devices (IUD).  While very effective as a temporary method of menstrual control, hormone therapy often fails to adequately reduce the menstrual flow and on occasion may result in unpleasant side effects such as weight gain, acne, or bloating.  Some women have various medical conditions that preclude taking hormonal medications such as cardiovascular disease and blood clotting abnormalities. 

Dilation and Curettage (D&C)

Dilation and curettage, also known as D&C, is a minor surgical procedure in which the top layer of the uterine cavity is scraped away.  While frequently recommended in the past for the treatment of menorrhagia, this procedure is now considered ineffective for this indication and is mostly used as a diagnostic method to determine the cause of heavy uterine bleeding.


Hysterectomy is a major operation that requires one to three days of hospitalization.  The surgery involves removing the uterus, either vaginally, laparoscopically, or through an even larger incision in the abdomen.  After hysterectomy, of course, you can no longer become pregnant.  Hysterectomy has the advantage of completely and forever eliminating the problem of excessive bleeding but requires hospitalization and carries the risk of other major abdominal operations including severe infection, blood clots, and post operative hemorrhage.  Depending upon the type of hysterectomy you have, complete recovery may take as much as four to six weeks

Endometrial Ablation

While not a completely new surgical technique, endometrial ablation, with newer methods known as “global ablation”, the procedure has evolved into an innovative technique and has generated a great deal of excitement within our specialty.  The newer global techniques of endometrial ablation allow surgical management of menorrhagia to be performed as a quick, outpatient procedure that removes the endometrial lining in a variety of gentle ways, including thermal heating or freezing of the lining.  Global endometrial ablation allows the procedure to be performed in an outpatient facility or even the doctor’s office with resumption of normal physical activity within a day.  In a significant majority of patients that undergo the procedure, endometrial ablation removes either all or almost all of the endometrial lining, resulting in a significant decrease or even absent menstrual periods.  On occasion, the procedure will not be satisfactory for control of your menstrual periods but complications of the procedure are much less common than with hysterectomy.  Contraception is still required after an ablation procedure. 

If you have difficult menstrual periods, I encourage you to discuss the various treatment options with your physician.  Before you choose from the options discussed in this article, your physician will perform an assessment to rule out serious physical causes of menorrhagia and will assist you in choosing the most appropriate method for treatment.  The options for successful treatment are better than ever before, allowing you the benefit of finding a procedure that more likely than not will either adequately control or eliminate the problem of menorrhagia.  

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