Treatment depends primarily on the cause and severity of the bleeding, their impact on social and emotional life, the age of the woman, etc. The menorrhagia can be caused by a disease that is essential to diagnose and treat (uterine fibroids, polyps, infection, cancer, etc.). In adolescent girls and premenopausal women, menorrhagia are more common. In this case, measures can be taken if necessary to avoid iron deficiency anemia, the most common complication.

To have some heavy periods can cause worry, fatigue and frustration. But this is not necessarily serious or worrying. It will therefore be beneficial to take the time to discuss with your doctor and ask him all the questions that come to mind.

pharmaceuticals

Nonsteroidal anti-inflammatory drugs. Nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil®, Motrin®, Nurofen®) reduce menstrual flow and reduce abdominal pain. They are very effective against menorrhagia in young girls, those of copper IUD users, as well as on “spotting” and metrorrhagia which occasionally accompany the taking of contraception or hormonal treatment (if spotting and metrorrhagia persist, it is necessary to consider changing the pill …)

Avoid taking aspirin since it contributes to bleeding.

Antifibrinolytics. These drugs can sometimes reduce bleeding, but their effectiveness is inconsistent. They work by making it easier for blood to clot in small blood vessels.

Hormonal treatments

Hormone therapy in tablets. When the symptoms of menorrhagia are considered distressing by the woman or they are harmful to her health, hormonal treatment may be prescribed: low dose birth control pill, the synthetic progestins or natural progesterone (Utrogestan®, Prometrium®) in tablets.

Medroxy-progesterone acetate injections (Provera®). It is a contraception blocking cycles for about 3 months. This method is used very little. It is sometimes effective but can be accompanied by a temporary disappearance of menstruation or, on the contrary, irregular menstruation. Also, unlike other treatments, it is not possible to stop the effects of an injection of Provera once it has been given. The ease of use of this method is therefore inconstant.

Intrauterine device with progestin. Progestins (substances related to progesterone) can be released directly into the uterus through an intrauterine device, the Mirena® or Jaydess® model IUD (smaller, intended for women who have not yet had children). This is implanted for a maximum period of 5 years for Mirena® and 3 years for Jaydess®. It thins the lining of the endometrium and thickens the mucus in the cervix (which prevents sperm from entering the uterus), without the side effects associated with conventional oral hormone treatments. Its rate of effectiveness in reducing menorrhagia (in the absence of a cause requiring treatment) is high if it is well tolerated and it can be withdrawn at any time. It is normal for random bleeding to occur during the first few months. However, it sometimes has drawbacks with a risk of acne and weight gain in women who are overweight (or who have gained a lot of weight on the pill or during pregnancy).

Talk to your doctor about all of these possibilities and ask them to describe the advantages, disadvantages and side effects to you.

When the hormonal treatments described above are not effective in reducing the menstrual flow, the doctor may suggest danazol (Danatrol®, Cyclomen®) or an analogue of gonadotropin releasing drugs (a hormone produced by the hypothalamus also called LHRH for luteinizing hormone-releasing hormone). Danazol produces an artificial menopause by blocking secretion from the ovaries. It drives thestopping menstruation in the majority of women. These 2 drugs have sometimes significant side effects, which is why they are used only as a second resort.

Exploration and surgical treatments

In a small number of cases, when the cause of bleeding is not known or cannot be treated with a drug, additional explorations or surgical procedures may be suggested.

Ultrasound. It is a simple and painless test. It allows you to visualize the shape of the uterus and to diagnose certain causes of bleeding (fibroma, polyp, endometrial hypertrophy, cancers) or, on the contrary, indicate that the uterus is perfectly normal and thus reassure about the benignity of menorrhagia and other bleeding.

Hysteroscopy. This method has diagnostic and therapeutic functions. First, the hysteroscopy allows the surgeon to see on a screen the internal state of the uterus, which allows him to precisely determine the cause of the menorrhagia (presence of polyps, cysts, etc.). The surgeon will make his observations using a hysteroscope. It is an elongated instrument fitted at its end with an optical system. Hysteroscopy is also used for the removal of polyps and the ablation of the endometrium.

Endometrial ablation. Endometrial ablation is the most widely used surgical treatment to reduce heavy bleeding associated with excessive endometrial development. This procedure consists of thinning the inner wall of the uterus using different techniques. It is performed only in patients who have very heavy bleeding and who do not have uterine disease (large fibroids, polyps, cancer). Endometrial ablation causes periods to temporarily stop or reduce. However, the effect of treatment may only last for a few years. About 10% of women who have had an endometrial ablation will subsequently undergo a hysterectomy. Endometrial ablation affects the ability to become pregnant. It can therefore only be offered to women who do not want to or no longer want to be.

Curettage. Curettage involves scraping the surface layer of the uterine wall. It is rarely used. It leads to a reduction in menstrual flow for the next few cycles, making it an effective short-term approach only. It is reserved for cases refractory to other treatments or as a diagnostic means of last resort. This procedure also removes a uterine polyp.

Hysterectomy. This is an operation to surgically remove the uterus. Traditionally, this removal of the uterus was common practice to stop heavy bleeding. Nowadays, it is a treatment of last resort as there are other options available to women. Hysterectomy offers a permanent solution, and of course can only be performed in women who have definitively renounced any pregnancy. One in five women today undergo a hysterectomy in North America and one in 10 women in France before the age of 60 and in more than half of cases, this procedure is done to treat menorrhagia. Hysterectomy requires general anesthesia. It can be done by abdominal or vaginal route, or by laparoscopy (insertion of a thin flexible tube into the abdomen), with or without preservation of the cervix.

Hysterectomy is not a benign intervention: it can lead to chronic pain, sexual problems, incontinence. It should therefore only be done if the bleeding is not controlled by another method or if the bleeding is real life threatening.

Other treatments

Iron supplements. If anemia is found (by a blood test) or if the ferritin level is too low, the doctor will prescribe iron supplements.

Notes. In all cases, taking iron supplements should be supervised by a healthcare professional.