Dr. Gafori is now taking YOUR questions! Email yours to: email@example.com and it might be an upcoming post!
First you go nine months without a period. Then, if you breastfeed, aside from the initial bleeding after having a baby, you might get lucky to go a year or possibly more without a period! So, when you get the “joy” of having it return, it can be some what of a shocker at just how much you, well, suddenly bleed. What’s with all the heavy bleeding? And, for some, why is there bleeding between periods? Breezy Mama turned to my favorite OB, Dr. Gafori, from IGO Medical Group, to get these questions answered.
Why do some women suffer from heavy bleeding?
Menorrhagia or heavy bleeding affects anywhere from 10-35 percent of women. It is one of the more common problems that leads to an appointment with the gynecologist. It can affect woman of any age group and the causes are different for each age group. Evaluation includes a history which helps determine the severity of the bleeding and whether or not it affects daily life (examples: dizziness or fatigue from anemia, the need to skip days at work, the inability to wear certain clothes, the need to put a towel underneath you when you are sleeping so that you don’t leak through onto your bed). Physical examination and blood tests (pregnancy test, tests for anemia or coagulopathy), an ultrasound of the pelvis, and possibly an endometrial biopsy.
In general, there are a few main causes….hormonal imbalance, structural causes (fibroids, polyps) that don’t typically respond to hormonal treatments, underlying medical problems like hypothyroidism, and precancerous or cancerous lesions. Some women say that their menses are heavier after having children, particularly if they have had a tubal ligation. Many women also suffer from heavier bleeding as they get older.
Why do some women have spotting between their periods and what causes it?
Spotting between periods should be evaluated by a gynecologist. It can often be caused by a benign process like polyps or fibroids, ovulatory dysfunction, infections, use of medications, or by precancerous or cancerous lesions. The treatment can include adjusting medications that a patient may be taking (birth control pills), surgically removing polyps or fibroids, or performing a hysterectomy in the case of a cancerous source of bleeding.
What are the options for treatment of heavy bleeding:
Medical Treatment: The most commonly used treatment for prolonged or heavy bleeding is the combination oral contraceptive pill (the birth control pill). Other hormonal treatments include the progesterone containing IUD (Intratuterine device), the Nuva Ring vaginal contraceptive, NSAIDS (medicines like ibuprofen and allege).
Surgical treatments: These are reserved for patients who have failed trials with medications, have contraindications to the use of hormonal treatments, or those who just don’t want to use hormonal treatments. Some of these are also reserved for women who have completed childbearing.
- 1. Hysteroscopy with polypectomy or myomectomy. This is a minimally invasive surgery in which we put a camera into the uterus through the vagina and then can visualize any lesions and remove them. Polyps or fibroids in the endometrial lining can cause heavy bleeding and sometimes treatment for this is as simple as removing the lesion.
- 2. Endometrial Ablation: A minimally invasive surgery that improves bleeding in approximately 80 percent of women. (This procedure is one that patients end up loving….I always show a pamphlet that I have with a lady walking on the beach in white….something most women with menorrhagia would never dream of doing). Last week, I happened to see three of my patients in the office that I had performed ablations for and all three of them started crying when we talked about how much their lives had changed for the better post procedure.
- 3. Hysterectomy: This can be performed in the traditional way using a large abdominal incision, vaginally, or by the minimally invasive route either by laparoscopy or by robotics.
Have a question you’d like Dr. Gafori to answer? Email it to: firstname.lastname@example.org!
Want to stay up to date on all the latest? Subscribe to receive the Breezy Mama newsletter email (it’s free!).
About Dr. Gafori:
Valerie Gafori MD, FACOG is a board certified obstetrician/gynecologist. She completed her undergraduate degree in Physics at MIT, her masters degree in Biology at Stanford University, and medical degree at UMDNJ: New Jersey Medical School. She completed her residency in OB/GYN at George Washington University and joined a private practice in Washington DC for one year before she moved to La Jolla. She is now in private practice in La Jolla, California with IGO Medical Group. She has special interests in minimally invasive surgery and gynecology.