Q: I'm a 39-year-old female. In the last three to four months, I've been experiencing changes in my menstrual cycle marked by excessive bleeding and clotting. My gynecologist has suggested cryoablation of the uterus. Are there alternatives or is this the best procedure?
A: The best way to treat excessive or prolonged menstrual bleeding depends on the cause.
Excessive or prolonged menstrual bleeding is called menorrhagia. It is difficult to measure the actual amount of blood lost during a period so the diagnosis is usually made by assessing the menstrual symptoms.
- Needing to change a pad more often than every 3 hours during the day or needing to change a pad during the night
- Soaking through both a tampon and pad
- Passing large blood clots
- Feeling fatigue and other symptoms of anemia
Three main types of conditions cause menorrhagia:
- Hormone imbalance
- Uterine growth (such as a fibroid or polyp)
- Bleeding disorders
Menorrhagia due to hormone imbalance can be treated with medicines or by surgery. Which one to choose depends on the patient's age, preference, plans for pregnancy and medical condition. Oral contraceptive pills or pills or injections that contain progesterone only are often effective. They also offer contraceptive benefits. There's also an intrauterine device that contains progesterone (Mirena IUD). It's very effective, reversible, and usually well tolerated. It can be placed during an office visit and does not require anesthesia. That's a significant benefit compared to surgery.
Bleeding from a growth is often best treated by removing the abnormal tissue from the uterine cavity.
Bleeding disorders are rare. They may require specific therapies, but the resulting menorrhagia can often be treated like a hormone imbalance.
Ablation of the endometrium is the surgical destruction of the inner layer of the uterus. This layer produces the menstrual flow.
Ablation can be done by:
- Freezing (cryoablation)
- Cautery (thermoablation)
The procedure usually requires anesthesia or sedation for pain control. Many women have cramping and discharge for several days afterward. Ablation is not for anyone who might want to get pregnant someday. And keep in mind that ablation does not prevent pregnancy.
Hysterectomy is the surgical removal of the uterus. It is the most definitive way to treat menorrhagia. However, this is major surgery and results in permanent sterility. It is usually only chosen as a last resort after other procedures have failed to control the abnormal bleeding.
(Joan Marie Bengtson, M.D., is Assistant Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School and a member of the Department of Obstetrics, Gynecology and Reproduction at Brigham and Women's Hospital, Boston, Masschusetts.)
(For additional consumer health information, please visit www.health.harvard.edu.)
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