Managing Menstrual Misery

Some women suffer from irregular periods, heavy menstrual flow, painful cycles, or even a combination. We group these symptoms into the broad category of ‘menstrual misery.’

A physical exam, as well as possibly a pelvic ultrasound, or perhaps other testing, may identify the reason for your menstrual misery – perhaps endometriosis, or fibroids, or a polyp. Sometimes no specific reason is found. When we can find no specific cause, we call that UBA – Uterus with a Bad Attitude.

  • What are the options for improving Menstrual Misery?

    1) Do nothing.
    This is often an option. Sometimes our patients just want reassurance that their symptoms are not a warning sign for something harmful, and they choose to decline medicines or procedures. Sometimes menopause is near, and they simply prefer to avoid intervention and wait for cycles to end naturally.

    2) Hormonal Management.
    This can sometimes be achieved with 'menstrual control pills,' also called 'birth control pills,' or with other hormones. Some women have risk factors that make this option not possible; some have side effects that make them choose not to pursue this solution. Smokers can have increased risks and can be ineligible for hormonal management.

    3) Hormone IUD.
    An IUD is a piece of plastic you wear inside your uterus. It is designed to go there, similar to a contact lens designed to be worn in the eye. The Mirena IUD often improves bleeding after several cycles. In slender wearers the menstrual cycles often get very light and sometimes stop. The hormones stay in the lining of the uterus; only an insignificant amount of hormone finds its way to the bloodstream. We can place an IUD during an office visit, and it can stay in place for 5 years. It also provides birth control! Its effectiveness is about the same as endometrial ablation (discussed next), although it takes longer to be effective.


    4) Endometrial Ablation.
    This process involves applying energy to the lining of the uterus - either electric or hot water - and inactivating the lining of the uterus. The ovaries continue to function normally. We are able to perform this procedure for many patients in our office, and thereby avoid the additional inconvenience and cost of an IV line, the operating room, and anesthesia. We have performed more than 30 ablations in our clinic; all patients have said they were glad to avoid the operating room. Not all patients are candidates for in-office ablation.

    In our office we have two techniques available. Both techniques involve taking pills prior to the procedure for pain control and sedation (you'll need someone to drive you home), and injection of local anesthesia during the procedure. One technique uses a wire mesh to cauterize the lining of the uterus - we call this 'the barbecue'. The other uses hot water to inactivate the lining of the uterus; we call this 'poaching' (as in cooking, not hunting).
    The success rate for ablation generally follows a 40-40-20 distribution pattern. 40% of the time periods are gone; 40% of the time they are better; 20% of the time the industrial strength uterus marches on. The size and shape of your uterus - and you - can greatly influence whether or not you are a candidate for endometrial ablation, and influence the degree of success.

    5) Hysterectomy.
    A subtotal or supracervical hysterectomy involves removal of just the part of the uterus that generates menstrual periods; the cervix and the ovaries and tubes remain. A total hysterectomy removes the uterus and the cervix. When we remove the ovaries and tubes, we talk about adding salpingo-oophorectomy, abbreviated as SO. That can be bilateral - BSO - or left or right - LSO or RSO.

    This option is obviously a major decision. For many of our patients, it has been made easier because of laparoscopic surgery, also called minimally invasive surgery. We have performed over 300 Laparoscopic Supracervical Hysterectomies (LSH) in the past four years, and the rapid recovery for most of our patients is amazing! Please visit our web page to learn more about LSH. Usually patients are back to their normal lifestyles within 10 to 14 days. One patient, an office manager, had surgery Monday and was back in the office Friday. Another was a truck driver, and was back at work in about a week. (As the commercials say, 'these results may not be typical. For best results, consult a physician').
    Whether or not you are a candidate for 'scope surgery depends on many factors.

    Other approaches include vaginal hysterectomy - typical recovery time 2 to 4 weeks - and abdominal hysterectomy - typical recovery time 4 to 6 weeks.