Heavy Periods? Don't Suffer in Silence, Says Dr. Jeremiah McNamara

Menstrual periods can be downright miserable. But for some women – about 1 in 5 – the flow is so heavy that it becomes physically and emotionally debilitating. They miss work, school, sports and other everday activities.

"Unfortunately, too many women suffer needlessly in silence from heavy menstrual bleeding. Studies show they tend to avoid bringing the subject up with their doctors," BCH gynecologist Dr. Jeremiah McNamara of Boulder Women's Care said during a free health lecture held at the Boulder Jewish Community Center.

"But there are a wide variety of highly effective treatments available for managing heavy periods, ranging from lifestyle changes and medications to surgery," he said.

Symptoms of Abnormal Periods
Known as menorrhagia, the symptoms of abnormal heavy periods include:

• Soaking through a single pad or tampon every hour for consecutive hours
• Needing to use double sanitary protection to control your menstrual flow
• Bleeding for longer than a week
• Tiredness, fatigue or shortness of breath resulting from menorrhagia-triggered anemia

Causes of Heavy Menstrual Bleeding
“Sometimes the cause of heavier than normal or prolonged menstrual bleeding is from anatomic issues within the uterus. Other times, it’s from hormonal influences. While some cases have no clear cause,” Dr. McNamara explained.

Common anatomical issues include uterine fibroids (noncancerous tumors of the uterus) and endometrial polyps (small growths on the lining of the uterus).

If a hormone imbalance is the problem, your body can make the lining of the uterus too thick. When it sheds this thicker lining, menstrual bleeding becomes heavy. "There are a number of reasons for your hormones to get thrown off, including menopause, obesity, weight change, stressors, inherited bleeding disorders and thyroid problems," said Dr. McNamara.

What Can We Do About It?
To pin down the root of the problem, Dr. McNamara said he begins a patient's medical visit with "a careful conversation about what's been going on. Then I may order some bloodwork, or maybe an ultrasound. The bloodwork looks at hormones and thyroid function, while the ultrasound is the best way to evaluate fibroids or polyps."

Treatment will depend upon the cause. Options include lifestyle changes, hormone therapy and medical procedures.

Lifestyle changes
Here are some actions you can take to lessen heavy bleeding:

• Maintain a healthy weight - Being either over or underweight can affect your menstrual cycle. If you're overweight, excess fat can cause hormone imbalances, which can result in a heavy flow. Also, losing pounds can impact your hormones. "Even a small amount of weight loss can lead to dramatic changes in your period," Dr. McNamara warned.
• Reduce stress - Stress has a complex relationship to your monthly hormones, and both physical and emotional stressors can lead to abnormal bleeding.
• Try over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) - NSAIDs, such as ibuprofen or naproxen sodium, can dramatically decrease bleeding and be used as a first-line option.

Hormone therapy
According to Dr. McNamara, certain hormone treatments can relieve heavy bleeding and "often with very low doses, and thus minimal side effects." He said some of the most common options include:

• New, ultra-low-dose birth control pills.
• The birth control shot that provides three months of benefit with one shot.
• A skin patch or vaginal ring called NuvaRing.
• Long-acting options such as Nexplanon (a small plastic rod placed under the skin of the arm) or an intrauterine device (IUD) that releases hormones.

Medical Procedures
If lifestyle changes or hormone therapy are unsuccessful, your doctor might recommend that you undergo a medical procedure to reduce or stop your heavy bleeding. "Some of these procedures are very quick in-office treatments, while others are bigger surgeries," Dr. McNamara said.

IUD (Mirena) - According to Dr. McNamara, this small T-shaped device sits painlessly inside the uterine cavity. "A lot of people think that the Mirena IUD is just for contraception, but it was originally invented to treat heavy or irregular bleeding – and it's amazing at it," he announced. "We insert this device in the office every day and most of those women have very light or no periods at all for the next five years, all in a way that is totally safe for the body."

Endometrial ablation - For women with heavy periods who want to avoid hormones, endometrial ablation is a good option. "With an ablation, we insert a device into the uterine cavity, which spreads out and touches all the surfaces of the endometrial lining. It very carefully burns that endometrial tissue so that it can no longer bleed." He added, "The result for most women is no more bleeding – ever. No hormones, no incisions, and a very fast recovery."

Hysterectomy - If you've tried other options and still suffer heavy bleeding, your physician might recommend hysterectomy. "Hysterectomy isn't where we should jump to right away for everyone, but the procedure can be a major life-improver for many women," Dr. McNamara stated.

Minimally Invasive Robotic-Assisted Hysterectomy
"We offer a cutting edge option for minimally invasive hysterectomy," Dr. McNamara said of BCH's da Vinci robotic-assisted surgery system. "A traditional hysterectomy involves one large incision and has a long recovery. With da Vinci surgery, we can operate through a few tiny incisions and accomplish the same thing, and in a way that is much better for the patient and her recovery."

Compared to traditional hysterectomy, robotic-assisted hysterectomy offers important benefits, including significantly less pain, less blood loss, shorter time in the hospital and quicker recovery at home. "Amazingly, you could go home the same day, but doctors often recommend just staying one night then home the next morning," Dr. McNamara said.

If you wish to schedule an appointment with Dr. McNamara, call 303-441-0587.

Click here to view PowerPoint slides from Dr. McNamara's lecture on "Relief for Heavy Periods and Other GYN problems."

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