You Don't Have To Go With The Flow!

You Don't Have To Go With The Flow! You Don't Have To Go With The Flow!

By: Lynn Simpson, MDHolly L. Thacker, MD • Posted on May 14, 2020 • Updated May 24, 2023

Heavy Bleeding Does Not Always Mean Hysterectomy

Do you ever get tired of being told to go with the flow? I do! Just because many midlife perimenopausal women experience heavy menstrual flow, it does not mean they have to accept that. And you do not have to choose to have a hysterectomy to cure the problem either!

In the past, it was said it was a 'right of midlife passage' to have to undergo a dilation and curettage (D&C) for heavy bleeding and almost 1 in 3 women ended up with a hysterectomy by age 60. Now, women rarely undergo a routine D&C. Rather, office evaluations find the cause of the heavy bleeding by performing one of the following:

  • Pelvic exam
  • Office endometrial sampling
  • Saline (salt water) Infusion Sonogram (SIS) of the uterus with or without endometrial sampling
  • An office hysteroscopy (a lighted scope to look inside the uterus right in the office)

Once hormonal imbalance, infection, polyp, fibroid or the rare cancer or pre-cancer is diagnosed, the specific problem can then be treated.

Treatment Options for Heavy Menstrual Bleeding

For women who have undergone full evaluation and who do not have any anatomic problems noted, there are treatment options for heavy menstrual bleeding.

  1. Natazia® - FDA approved, hormonal contraceptive agent used for contraception and for the treatment of heavy menses in women desiring contraception. This agent, which includes bio-identical estrogen has been studied in women up to age 50.
  2. Mirena® Intrauterine System - Approved for contraception for up to 6 years in the US and approved to use as a therapy for heavy menses (and in Europe is used up to 7 years).
  3. Lysteda® Tranexamic Acid - A non-hormonal clot promoter that can NOT be used with hormones.
  4. Uterine fibroid embolization of fibroids - In general, this option is only selected in a woman who does not plan on future childbearing.

Hormonal options such as Natazia® and the Mirena® IUS do not preclude the option of future childbearing.

When to see a Women's Health Physician

If you flood or soak through pads and tampons and loath to ever wear any white clothes, then you need to see a women's health physician pronto! If you are anemic (have low blood count) which can cause unusual cravings (called pica) you need to be evaluated and treated. Chewing on ice cubes can be a sign of low iron as well as craving dirt or kitty litter!

  • Sometimes thyroid problems or bleeding disorders are the culprit but most often it is a correctable anatomic problem like a fibroid or a polyp that can be treated with minimally invasive techniques.
  • Other times it is a hormonal imbalance that can be treated without hysterectomy or any procedure.
  • Sometimes, a hysterectomy is needed, particularly if fibroids are larger than a five-month pregnancy or in the case of cancer or pre-cancer.
  • However, you and your doctor should consider all options before resorting to major surgery, particularly in the instances where hormonal imbalance is the cause.

So, this is one instance where you should not go with the flow, as you will feel so much better by controlling that flow!

Be Strong, Be Healthy, Be in Charge!

-Lynn Simpson, MD and Holly L. Thacker, MD

Lynn Simpson, MD is a retired physician who worked in the Center for Specialized Women's Health at Cleveland Clinic. Dr. Simpson earned her medical degree from The Ohio State University College of Medicine and Public Health. She completed her residency in OB/GYN at Grant/Riverside Methodist Hospitals in Columbus, Ohio. Dr. Simpson was a physician at Cleveland Clinic from 2010-2021. She has numerous publications in Obstetrics and Gynecology.

Holly L. Thacker, MD, FACP is nationally known for her leadership in women’s health. She is the founder of the Cleveland Clinic Women’s Health Fellowship and is currently the Professor and Director of the Center for Specialized Women’s Health at Cleveland Clinic and Lerner College of Medicine at Case Western Reserve University. Dr. Thacker is also the Executive Director of Speaking of Women’s Health and the author of The Cleveland Clinic Guide to Menopause. Her special interests and areas of research include menopause and related medical problems including osteoporosis, hormone therapy, breast cancer risk assessment, menstrual disorders, female sexual dysfunction and interdisciplinary women’s health.

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