“Annuale’s not for everyone. Do not take if you are using MAIO Inhibitors or if your occupation requires you to operate heavy machinery. Do not take Annuale if you ever plan to become pregnant, as it may turn your baby into a firemonster. In the days around your period, you may develop a leathery tail. Annuale may cause you to develop a second vagina. Notify authorities in your town when your period is imminent as they may want to incarcerate you pre-emptively like a wolfman.”

The above “ad” is from a Saturday Night Live skit, imagining what a once-a-year period would be like. No offense Tina Fey (who IMHO is generally awesome), it does not have to be this way.

Heavy and/or irregular periods are the bread and butter of a gynecologist’s practice. It used to be that there was one solution: hysterectomy. But thank God (and medicine) that there are many newer options.

Before exploring these options, you should be evaluated by an experienced gynecologist to rule-out common and often correctable causes of heavy bleeding. If you are an adolescent or teen with very heavy periods, your provider may want to make sure that you do not have a blood-clotting problem. There is a disorder called von Willebrand Disease (VWD) that affects approximately 1% of the population, but is in roughly 15% of women with very heavy periods. Easy bruising and bleeding gums are other red flags that can lead to this diagnosis.

If you are an adult and your bleeding is gradually getting heavier, you may have a polyp in your uterus or fibroids. Your provider may want to do an ultrasound or if your bleeding is at all irregular, a biopsy of the lining of your uterus.

Assuming that you do not have an obvious cause of your heavy periods, that you are just plain unlucky, these are options you should consider:

Birth Control Pills:

The easiest, quickest and cheapest option for heavy bleeding is birth control pills. News flash: if you have no need for contraception, you can still use the pill to control bleeding! Insurance companies really have no idea that your spouse had a vasectomy or that you do not have sex with men. At least for now, birth control pills are still covered by most insurances.

But pills are not for everyone. Most pills have both estrogen and progesterone, and it is the estrogen that can be dangerous. If you have a history of migraines with aura or blood clots in your legs or lungs, birth control pills are not a good idea. Progesterone is generally safe even with these other issues and progesterone-only pills (the “mini-pill”) are a good option. But not every woman tolerates pills.

Levonorgestrel-containing IUDs:

These are Mirena, Kyleena and Skyla and all will make your periods either non-existent or at least much lighter. They only have progesterone, no estrogen, so they are safe for most women. If you have heavy periods, stay away from Copper IUDs. I repeat: do not get a copper IUD if your period is already heavy and/or painful! It will make it worse.

Lysteda (Tranexamic Acid):

This medication has been around for many years, is safe and works very well. It is not a hormone but more related to NSAIDs (i.e. Ibuprofen, Naproxen) and truly in a class by itself. I am convinced that the only reason it is not more popular is a lack of marketing on the part of Big Pharma. I just don’t understand why we see ads on TV for medications that affect 0.001% of the population (Acrodermatitis Enteropathica?) and not for Lysteda. But I digress.

A woman takes this medication three times a day on the heaviest days of her period, whether this means 1 day a month or 4 days a month. It significantly decreases the amount of blood flow, so perfect to use on an as-needed basis. Let’s say you know that day 2 and 3 of your period are going to be super heavy and you have a big presentation at work and don’t want to bleed through your clothes. That’s when you take Lysteda. Like many great under-the-radar medications, this one is popular in Europe but also available in the US.

Endometrial Ablation:

This is essentially burning the lining of the uterus (endometrium) and is successful 80 - 90% of the time in decreasing period flow and often completely stopping periods. Novasure Endometrial Ablation is one of the most common methods because it is safe, effective and has very little down time. Endometrial ablations often stop periods completely (amenorrhea). I perform these in the operating room where anesthesia can make this a quick and painless procedure.

Important side note: When your endometrium is ablated or even when your whole uterus is removed, it does not put you in menopause. Regardless of what happens with your uterus, your ovaries are on autopilot. You may still get PMS symptoms if you had them before, but on the positive side you won’t have hot flashes and other menopause symptoms.

In short, do not let Aunt Flo put you into exile a few days of each month because of heavy bleeding. There are a lot of options, including non-hormonal options. Come see us at Evergreen Women's Health if you are tired of periods affecting your quality of life.

Dr. Cynthia McNally, MD

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