Vaginal Bleeding is an inevitable part of most women’s lives. It can start as early as age 9, and last well into the 50’s. Luckily the system is set up so that bleeding is usually manageable and we can still get on with our busy lives, but there are often times when bleeding can interfere with quality of life, and can even be life threatening.When this is the case, it is worth investigating what options there are to potentially improve the situation. Appropriate treatment of course depends on the woman (or girl’s) age, the pattern and level of the bleeding, and the immediate and longterm health goals of that person. In general , the treatment choices can be divided into 2 broad categories –‐treatment with medicine, or treatment with a procedure.

IMG_1668Medical Treatment 

NSAIDS such as Ibuprofen. These medicines ,when started at the very onset of the bleeding, and continued regularly throughout the episode, are extremely effective in controlling pain, and in some cases, significantly decrease bleeding as well. Lysteda, or tranexaminic acid. This medicine,when started at the onset of bleeding is very effective at slowing the flow for up to 5 days/cycle. It works differently than Ibuprofen, directly on the blood vessels to cause constriction, and is therefore more effective in controlling bleeding than the NSAIDS.
Hormonal contraceptives such as pills, rings, patches, injections. These are extremely effective in improving blood loss(as well as pain). They are the most common treatment for bleeding issues in the younger women, and are still safe to use for many women in their 40’s and 50’s, even when contraception is no longer an issue.
Progestin–containing IUD such as Mirena. This 1×1 in. flexible T shaped plastic device is easily inserted in the office. It releases a very low dose of hormone, similar to what’s in very low dose birth control pills, but has the advantage that very little of the hormone gets into your bloodstream, so side effects and risks are significantly lower than the pill. They usually last 5‐6 years, sometimes longer.

The Mirena website:  http://www.mirena-us.com/is-it-right-for-me/mirena-and-your-period.php

Procedures
Endometrial Ablation is a 2 minute office based procedure whereby the endometrial cavity, (inside of the uterus), is cauterized. This seals most of the blood vessels that empty into the cavity when you are bleeding. It also creates a layer of scar tissue, so that the lining does not keep regrowing and wanting to shed. 90‐95% of women are significantly better after an ablation. Half don’t bleed at all, and the other half have a very light flow, MUCH better than before.

Useful link: http://minervasurgical.com

Hysterectomy is removing the uterus. This is the only 100% cure for never bleeding again. But it is also the most invasive. It is major surgery, which entails some immediate risk, no matter how healthy you are, and takes times for recovery, about 4‐6 weeks on average. Removing the uterus does not necessarily mean the ovaries, so there does not have to be any hormonal change, just no more bleeding. It can be done through the vagina, or through the abdomen, and sometimes a laparoscope is used.. Your anatomy and circumstances, as well as the expertise of the surgeon will determine the route. You always want to chose the least invasive route when medically possible and safe.

In general, if your anatomy is normal,meaning your uterus and ovaries by exam and ultrasound do not indicate a significant anatomic abnormality, you should consider trying at least a few of the lesser invasive treatments before moving on to hysterectomy. But all of the above options may not be appropriate for you, so it’s important to weigh the pros and cons of all of them before making a choice. In summary, if bleeding is significantly interfering with your life, you probably don’t have to live with it.