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Heavy bleeding (hormonal imbalance, no fibroids) - what is the next step?
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An_255432 posted:
I have been looking through the site, but have seen very little in the menopause section to address women who have heavy bleeding during perimenopause.

I am 52 and started experience bleeding issues in 2008. Prior to my first experience of a two week period, I had always been regular with no major issues. I didn't panic, knowing that I was approaching that phase of my life, and made an appt. with my PCP. She ordered blood work to check hormones and thyroid and sent me for an ultrasound, which did not indicate any fibroids or ovarian cysts. She referred me an OB/GYN.

The OB/GYN did an endometrial biopsy, which came back inconclusive because of the bleeding, which led to hysteroscopy/D&C. Results: bleeding was caused by hormone imbalance (multiphasic uterine syndrome, I think), estrogen, but no progesterone, which is not uncommon and started me on birth control pills. After six months on the pill, I still had very heavy periods (although they did not last as long) but I had significant break through bleeding regularly. When I went back for a follow-up and shared this with the OB-Gyn, he recommended using Mirena IUD. Since it lasts 5 years, when it was time to take it out, I would most likely ready for menopause. I took the information home and read it, but did not feel comfortable using an IUD. The next appt led to a very unpleasant discussion with the doctor (I was irrational for not wanting to use the IUD and you won't go through menopause while taking the pill) I left feeling really stupid and really angry. I did not go on Mirena and after a year on the pill decided not to go back to the doctor for a refill and see if nature would take it's course. (Big Mistake) For the next 9 months my periods were regular again. After that they started getting closer together and lasting longer and getting heavy again. Last month I finally went back because of an exceptionally bad episode, The doctor immediately prescribed Prometrium for 10 days (generic) did another endometrial biopsy, and sent me for blood work. I almost waited too late because I was so anemic I had to have 3 units of blood and an iron infusion. (Hemoglobin was 5.2, iron was 2, yes 2).

I met with the doctor this week. Still the same diagnosis - hormones run amuck. The options - birth control pills again, IUD off the table because now I'm 52, ablasion, which he thinks would stop the heavy bleeding but would be constant light bleeding, or progesterone only. He did add, somewhat relunctantly, we could always remove the "offending organ".

So I really don't think the pills will work this time, since they didn't work the first time. And although my husband has been absolutely understanding through all this, any bleeding is a turn off when it comes to being intimate, My mother and grandmother were both in mid 50's before going through menopause - so chances are I'm looking at another 3 years at this point, (neither had these problems). Am I crazy for wanting to have a hysterectomy? I know people with heavy bleeding due to fibroids often have them, but not much info out there for hormonal imbalance, and especially at my age.



Has anyone been through this? I'm just really not sure what to do!
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Anon_6061 responded:
So sorry for all your troubles! If it were me, I would opt for medical management versus any procedure. Some BCP's work better than others. Have you tried a progestin-only BCP? I don't understand why the IUD is "off the table." I know post-menopausal women older than you who have gotten them because they take estrogen.

Has any doctor mentioned prescription Lysteda or Cyklokapron (tranexamic acid)? It's a non-hormonal med you take just during your period to reduce flow. NSAID's such as Aleve or Motrin especially in prescription strength and taken on a regular schedule at the start of bleeding are also fairly effective. This link lists the pharmaceutical treatments for heavy bleeding and their effectiveness - http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0015970/table/ch8.t1/?report=objectonly.

I assume you are taking a highly absorbable form of iron? If you take it with vitamin C (and away from calcium) it will enhance absorption.

Have you tried a disposable or reusable menstrual cup (Moon Cup, Diva Cup, Instead) to reduce the need to change tampons and pads so often?

I had a hysterectomy and it has caused problem after problem. My bladder and bowel have shifted and bowel issues started immediately after surgery. Bowel function has never been the same along with bladder issues off and on. My vagina is now falling. Sex has never been as satisfying and I have no libido. Hysterectomy is also associated with a fairly high rate of ovarian failure. An intact woman's ovaries produce hormones into her 80's especially testosterone. There's a Medscape article on the Long-term Effects of Hysterectomy that would be helpful in making this decision.

There have also been some long-term studies on endometrial ablation showing it can cause some adverse effects up through the 8 year study follow-up. Any time you mess with mother nature, it can cause problems. And with a permanent procedure, you are stuck with the good and the bad. Good luck to you!
 
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Anon_6061 responded:
One thing I forgot to mention - Chances are this is all just due to perimenopausal changes in ovarian hormones. However, thyroid problems can cause changes to your menstrual cycle so you may want to rule out a thyroid problem. A clotting disorder is another possibility (von Willebrand's is one of the most common types and can be hereditary or acquired).


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