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Your period does not have to be a sentence

By the time a woman reaches 45, her body would have experienced a monthly menstrual ritual for more than 30 years. At this age, she also is looking forward to the end of the ritual with menopause.

However, for one in five women, this is the beginning of a time of excessive menstrual bleeding. Clinically referred to as menorrhagia, this common type of abnormal uterine bleeding is characterized by heavy and prolonged periods. In some cases, the bleeding is so heavy that it is necessary to miss work, school, or social activities.

With prolonged, heavy bleeding there is also an increased risk of anemia and the associated fatigue, which can significantly impede or limit one’s daily activities. Therefore it is not uncommon for women to feel isolated, frustrated, and controlled by the condition, as it can leave them house-bound for days at a time.



It is little wonder that growing number of women feel this time of the month is indeed a “curse.”

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The causes of menorrhagia fall into three general categories: hormonal imbalances, structural defects such as fibroids or endometrial polyps, and precancerous or cancerous conditions.

Hormonal imbalances cause changes in the menstrual cycle that can bring about dysfunctional uterine bleeding. As women enter the perimenopausal (before menopause) stage, estrogen levels tend to fluctuate sometimes leading to heavier, more frequent periods. About 30 percent of women will develop fibroids by the time they are 35. The likelihood of having fibroid is greater among African American women (40 percent).

Fibroids are usually benign, round muscle growths found outside, inside, and within the uterine wall. While there is some discussion as to what causes fibroids, their growth relates to estrogen production. Depending upon their location, it is not uncommon for fibroids to cause abdominal or back pain and urinary problems. As a fibroid becomes larger, a woman may experience excessive menstrual flow along with pain. Another cause of menorrhagia are precancerous or cancerous growths. Sometimes because of a hormonal imbalance there is an overgrowth of the endometrial lining known as hyperplasia. This thickening of the lining can lead to increased bleeding. Usually, the condition is diagnosed by a biopsy or D&C. Postmenopausal women or women on continuous hormone therapy who begin to bleed, should seek a medical evaluation to rule out a possible precancerous condition.

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Finding the most appropriate treatment for menorrhagia involves several diagnostic tests, which may include hormonal studies, an endometrial biopsy, and/or an ultrasound. Some gynecologists recommend a sonohysterogram, which is commonly referred to as a water ultrasound, and helps further determine any abnormalities inside the uterus.

Depending on the results of these tests, a patient may undergo more extensive diagnostic testing such as a hysteroscopy with dilation and curettage (D&C). With hysteroscopy, the gynecologist can visualize inside the uterus to locate fibroids or endometrial polyps that may be causing the menorrhagia. The D&C provides tissue sampling to determine the health of the lining of the uterus much like an endometrial biopsy. After the diagnostic testing is complete and the cause has been confirmed, what are the treatment options for menorrhagia?

First of all, it is important to know that there are options. A long time ago, if a woman complained to her gynecologist of excessive menstrual bleeding, had a history of fibroids, and was 45 or older, the only option given to her was repetitive D&Cs or a hysterectomy. However, advances in medical technology now afford women an opportunity to evaluate other treatment options that may be more appropriate to their lifestyle.

Treatment options are highly individualize making it difficult to generalize which is best. Some women may do well with hormonal therapy to bring everything back into balance. When hormone therapies have failed, then women could consider surgical intervention. Even if this was the case, there are also options other than hysterectomy.

The most recent option for surgical treatment of menorrhagia is the endometrial ablation. First introduced in the 1980s, endometrial ablation is a low-risk, low-cost alternative to hysterectomy as a treatment of menorrhagia. Endometrial ablation surgical reduces or stops excessive menstrual flow. During ablation, sealing the blood vessels destroys the endometrium, which leads to more controlled, bleeding or no bleeding at all. What is used to destroy the lining of the uterus varies.

However, each has approximately the same success rate (85 percent) in achieving the desired outcome. The newer technologies, which theoretically have lower surgical risks, include the balloon ablation; the hydrotherm ablation, which uses hot water; cyroablation whereby the endometrium is destroyed by freezing it; and using bipolar electrodes which uses electric current to vaporize the lining.

On the South Shore, of the newer technologies, the balloon ablation and the hydrotherm ablation are available. They are quick, minimally invasive, and can be done in an outpatient basis. While endometrial ablation may sound like the cure-all, it is not for everyone.

A thorough medical evaluation encompassing a physical exam and assessment of a woman’s symptoms is an important part in determining whether endometrial ablation is the best treatment option for her menorrhagia.

Regardless of what a woman decides in terms dealing with her bleeding, it is important that she know that her period doesn’t have to be a sentence.

Contents of this article is for informational purposes only. In no way should it be taken as medical advise. Please seek the advise of your doctor for evaluation of any medical problem. For comments, please e-mail Norma Santiago at Tatisnis@aol.com


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