Monday, September 11, 2006

What do you know about menorrhagia?

A dear friend, P., is approaching menopause at 41 (even though she doesn't look a day over 25), and her last few periods have been bloody monsters—the one just past lasted two weeks (two weeks!) and was really heavy, to boot. Chunky clots (she said it looks like her body is disgorging an alien, bit by bloody bit). A tampon an hour. Blowouts requiring a trip home to change clothes. Painful cramping. And did I mention...two weeks! Bad, bad period, in other words. She clearly meets the criteria for menorrhagia, with the heaviness of the flow, how long it lasts, and how miserable it's making her.

Herewith, a few questions for anyone who has been through this herself, or knows someone who has:

1. What treatment(s) did you try? Did you get good results? (P. has had side effects from the pill, so she's looking for another option.)

2. What do you know about the NovaSure endometrial ablation technique? The website makes it sound like the biggest boon to bleeders. What's the down side (aside from having a thingamajig inserted into the uterus and cramping up afterwards, etc.)?

3. Got any coping strategies or pointers to offer?


Anonymous said...

Sadly, when this happened to my mother, she had a complete (that means everything--uterus, ovaries, tubes) hysterectomy. Ater four straight weeks of bleeding, the woman who had been regular for 30 years, on the dot(ha) went haywire and had it all out.
Except for the ridiculous effect of the hormones, she was then fine after a while and quit those too.

I think most suggestions is simply uterus removal, but keeping the ovaries for hormonal purposes.

All the best to your friend. I hope she finds a solution for herself soon.

Emma Goldman said...

Try acupuncture, and possibly chinese herbs (prescribed by someone who knows what s/he's doing!). When I was fighting with my fibroids (and it may be that your friend also has some, and they just haven't been particularly symptomatic), acupuncture definitely helped, both before and after the surgery. I can give you the name of someone I liked a lot.

Also, another friend of mine had an eight-day period like the one your friend had . . . and nothing since. It could be kind of a last-gasp thing. is she sure it's menopause and not fibroids? Because my fibroids caused bleeding, etc., like you're describing, and it doesn't take very much for them to do that. Feel free to email me for more.

Personally, I've been trying to avoid a hysterectomy, figuring (at 48) menopause can't be that far off. I don't want to cut bits out if I can avoid that.

JT said...

Okay, mine isn't menorrhagia, but with severe endo, I can relate to the horrible cramping and the ruining of clothes.

I can't do anything about the bleeding. However, for cramps, I prescribe:

Hot baths. Heating pads. Massive painkillers. And, of all things, stomach crunches. Sometimes it's the weirdest thing that helps. Also, the cramping can partner with IBS and they can both aggravate each other, so a bland diet would help when things are acting up.

Delia Christina said...

orange, as you know, i've recently had a heavy period that lasted TWO MONTHS. however, my most recent period lasted 5 days and was totally normal (heavy flow in the first 2 days, light flow afterward.) this menstrual unevenness is normal for me.

i've been tested for fibroids and none so far(knock on wood); nothing cancerous, nothing hormonal or endometrial. my doctors have always told me it's stress. typically, after bleeding clots the size of my palm for weeks on end, i get back on schedule - at that point, i'm also anemic, but on schedule. (i have to take iron regularly.) to correct my cycle i was once prescribed a light dose of birth control pills, but the side effects weren't agreeable and now my family history precludes it.

on the other hand, sometimes i skip periods altogether (again, for a few months at a time).

i've been like this since college (i'm in my mid-30s) so now i just go with the, uh, flow. if i skip two months, i know i'll probably be irregular for a few months and then i'll get back on track.

Anonymous said...

Has your friend been tested for fibroids? A friend of mine had similar symptoms (month-long period, lots of tampons, cramping) and finally found a doctor who diagnosed and then removed the fibroids (no surgery). She's fine now.

Anonymous said...

I have nothing helpful to add, but I couldn't resist chiming in to say that my periods were just like that for YEARS. From the very beginning, they lasted two weeks--which means, of course, that I was on the rag half the time. I didn't even know it was something abnormal. It wasn't until I went on the pill (at age 17) that I experienced the luxury of five-day periods. Most of my friends had three-day periods on the pill, but five days as opposed to fourteen was heavenly.

Anonymous said...

The local news station ran a piece last night on a procedure called endometrial ablation that you and your friend might find interesting: I have endometriosis and it's something I'm definitely considering!

Anonymous said...

The Novasure procedure is presented as a quick and easy fix for heavy menorrahgia. For some it is a simple, and fast procedure. For others it can be a dangerous. I'll explain, Novasure falls into a class called Global Endometrial Ablation (GEA) devices. GEA was developed to replace another procedure called Endometrial Ablation or "Rollerball". The GEA devices that were borne out of this technology advance were 1.Cryoablation (Cryo)-frozen probe inserted into the uterus and guided via ultrasound(approx 30 minute procedure), 2. Hydrotherm Ablator (HTA)- whereby heated saline(87c) is circulated via hysteroscopy within the uterus(approx 25-30 minute procedure), 3. Ballon Ablation(Thermachoice)- uses a balloon tipped catheter which is inserted into the uterus, filled with "sugar water" and heated(87c) (approx 12-15 minute procedure), 4. Radio Frequency Ablation(Novasure)-utilizes an rigid electrical "array" that is inserted into the uterus and discharged(approx 6-8 minute procedure).

While all of these procedures can be performed safely by trained surgeons only one rises to the top as having the most PATIENT COMPLICATIONS...NOVASURE.

Novasure (according to the FDA's "MAUDE" database) has a significant complication profile almost 4x greater than the most widely used Balloon Ablation. It appears to have some inherent flaws in its design. 1. The rigid structure of the array can easily lead to uterine perforation. A laterally, retroverted, or anteverted displaced uterus(common in woman with uterine issues) does not accomodate the rigid array very well. Unless measurements within the uterues are accurately determined(minimum 2.5cm cornu to cornu), deployment of the device can and does at times lead to uterine perforation. 2. The device is only indicated for a uterine "cavity size" of 4-6cm. This size is determined first by "uterine sound", which is a measure of the uterus from the external opening of the cervix(external os) to the top of the uterus(fundus). Then the surgeon must determine "cervical length", by measuring from the external opening of the cervix(external os) to the internal opening of the cervix(internal os). The measurements are then subtracted from one another to determine "cavity size". For example: a woman with a "uterine sound"(measurement of external os to fundus) of 7cm, and cervical length(measurement of external os to internal os) of 3.5cm, has a "cavity size" of 3.5cm (7cm - 3.5cm = 3.5cm). Novasure is contraindicated in this patient. 3. Lastly, there have been reports of the "electrical array" melting it's own retaining collar making it impossible to close the array and withdraw it from the patient.

Closing thought, I am not a doctor and in no way am I giving anyone medical advice. Only a licensed and certified physician can administer these procedures. I am however a son, husband, father, and a consumer who believes that everyone should have a very good understanding of their health care choices, and if it were my mom, wife or daughter I would want the safest, not the fastest procedure.

Anonymous said...

the safety profile of NovaSure is far better than anything else out there. the Maude data base showes the adverse event rate of NovaSure to be less that one half of one percent... NovaSure would not be the treatment option of choice by most physicians if it was not deemed safe and effective.

Anonymous said...

I researched my options for my heavy periods very carefully. I am 36 years old, a mother of three beautiful daughters and I have had 10 day periods since the birth of my last daughter 3 years ago. I opted to have the NovaSure procedure 14 months ago and it WAS THE BEST DECISION THAT I HAVE EVER MADE! The procedure was done in my doctors office. I was very comfortable during the entire thing. I have not had a single period since the procedure and it has changed my life. I can play with my kids, leave the house without a purse full of tampons and best of all I can plan events around my life and not around my periods. After reading the above blogger's concerns about the safety of the procedure, I asked my OBGYN at my annual papsmear. He informed me that this MAUDE database is flawed. He also informed me that the NovaSure procedure has been performed on close to 400,000 women world-wide, and is by far the most widely used device for this procedure. Best of luck, I can only talk for myself, but I couldn't be happier with the procedure.
(on a side note, I have three friends with the same problem- two of them are signed up for a NovaSure and the third went through a cryo ablation and hasn't seen a differene in her periods)

Anonymous said...

I had the Novasure procedure performed in March 2006. I did have some complications that made the experience very painful. First of all, I did have some nausea, but that is a common side effect of anesthesia. The morning after surgery I felt great. By that evening, I was feeling nauseous again. I called the doctor and she advised me to stop taking the antibiotic--I was probably having a reaction to it. By the next day I felt better, but then over the next several days I felt worse and worse-nausea, weakness, discharge, fever. Of course you can guess what happened--I got an infection. It was so bad that my OB-Gyn thought I had appendicitis and checked me in for a CAT scan of abdomen. It was just (!) a severe infection. I also had a bladder infection. The pain was worse than having a child--and I did natural childbirth. I eventually got back to normal and switched OB-Gyns. While having a ultrasound for ovarian cysts, she noticed that I have a bi-cornuate (heart-shaped) uterus and she would never have done the procedure on me. This was strange because before surgery, my OB-Gyn did do a ultrasound.

Two years and four months after the procedure I didn't have a period--until last month. I now have had two. Much lighter than before. My current Gyn said that the procedure is not as effective for people with a heart-shaped uterus.

I also now have hydrosalpinx, which is a inflamed, fluid filled fallopian tube, often caused by infection in the pelvic region. Coincidence? I don't know.

This is what happened to me and I don't think I've ever read about anyone else having this problem.