The Trouble With Menstrual Bleeding

Garry E. Siegel, MD

For time immortal, women have had to put up with the inconvenience, if not outright trouble, of a monthly menstrual cycle.  To many, it is a sign of normalcy and a monthly celebration of their womanhood.  To some, however, (especially as the years go on) the monthly visitor can be anything from a small bother to a huge problem in which time is lost from work, school, or family.

There have been many advancements in the field of gynecology that are now recognized to offer help to women of all ages.  The days of simply suffering are long past, and depending on one’s circumstances, there are many treatments that can be life altering.

During the reproductive years when women are not in a situation to compromise childbearing, there are medical treatments that can offer relief.  Simple hormonal medicines such as Oral Contraceptives (the birth control pill) have been around for over 50 years, but now there are newer, lower dose preparations that are quite low in potential side effects.  Options also exist that include a skin patch or a vaginal ring that allow even greater flexibility.  For women who have certain medical conditions that preclude pill usage, there are low-dose pills without estrogen as well as injectable medication that can very nicely control cycles.

Some women do not wish to have a daily or systemic medicine, and for those there are two other nice options.  A new medicine has emerged in the US market recently after years of success across the world.  This medicine, known as Tranexamic acid, is used only during the cycle to lessen flow.  Additionally, a product known as an IUD, or intrauterine device, has been FDA approved for use to lighten cycles.

In the past, women who’ve completed their families were offered hysterectomies (removal or the uterus and/or ovaries) to stop heavy menstrual flow.  While that certainly remains an option, what has changed is that there has been an explosion in new technology that has been lumped into a category called “Minimally Invasive Surgery.”   The hysterectomy of old, in which an abdominal incision was made, has in many cases been replaced by a minimally invasive approach, which in its purest form involves NO incisions and the surgery is performed transvaginally (this is somewhat deceptive; vaginal hysterectomy has undergone a resurgence, and the American College of Obstetricians and Gynecologists recently promoted a simply vaginal hysterectomy as the preferred route over “sexier” methods such as robotic and scope-based surgery, when applicable).  In some cases, the vaginal hysterectomy is not the best approach, and other procedures involving laparoscopy (1 to 3 small, “band-aid” incisions) can avoid a larger incision.

There are other, newer options that may avoid hysterectomy in those looking for other methods to alleviate bleeding.  For instance, some women can undergo office-based or operating room-based endometrial ablation, in which the uterine lining is destroyed such that menstrual flow is lessened or absent.  Additionally, for women with fibroid tumors (a common, benign tumor associated with heavy bleeding), a minimally invasive procedure known as “Uterine Artery Embolization” can be done as an overnight, hospital based procedure in which the blood vessels leading to the tumor are obstructed so that the tumors shrink.  North Fulton Hospital offers these procedures and others, helping the women in our community manage their issues with bleeding.

 Board Certified Obstetrician and Gynecologist, Dr. Garry Siegel practices at North Fulton Women’s Specialists (NFWS), an Obstetrics and Gynecology Practice located in Roswell, Georgia.  Serving residents of North Fulton and the surrounding areas, NFWS specializes in prenatal care & delivery, high risk obstetrics, and general gynecologic services including well women exams, family planning, endometriosis, teenage/adolescence care, infertility, and more.  The practice is open daily 8:30 am - 4:30 pm.  For more information about North Fulton Women’s Specialists or to schedule an appointment, visit www.NorthFultonWomensSpecialists.com or call 770.664.7013.