You Don't Have to Live With Excessive Menstrual Bleeding

Jan. 2 (HealthDay News) -- About 10 million American women struggle each year with a debilitating but little discussed health condition -- menorrhagia.

It's more commonly known as excessive menstrual bleeding, and it can result in fatigue, anemia, missed work days, restricted physical activity and embarrassment when accidents occur.

While "excessive" is relative, in general, menorrhagia refers to the need to go through more than three or four sanitary pads a day or to change tampons every hour or two, said Elizabeth Battaglino Cahill, a registered nurse and executive vice president of the National Women's Health Resource Center, an independent health information source for women in Red Bank, N.J.

In a survey of 600 women conducted by the center in 2005, researchers found that nearly 60 percent of women with the condition hadn't bothered to discuss it with a doctor, even though it was having an adverse effect on their lives and can be treated with a number of approaches.

When women do approach their doctor or another health-care provider about menorrhagia, Cahill said, there can still be more problems. "A lot of physicians are not explaining a lot of the treatment options," she said.

But an array of treatments can be used, including oral contraceptives or other drugs; dilation and curettage (D&C); and endometrial ablation (the removal or destruction of the endometrium, which is the lining of the uterus). Most drastic of all is removal of the uterus -- a hysterectomy, Cahill said. And, she added, many doctors may gravitate to hysterectomy too soon or for the wrong reasons.

But the patient-doctor dialogue may be changing. A survey published by the National Women's Health Resource Center in November found that more than 40 percent of women suffering from uterine fibroids, a major cause of excessive bleeding, did discuss with the physician the treatment option of uterine fibroid embolization. It's a technique in which the blood supply to the fibroids is blocked -- and the growths shrink.

Part of the problem in treating menorrhagia is that "there is no diagnostic test that tells you which of the multitude of treatments will work" in individual women. So, it becomes trial-and-error, said Dr. David F. Archer, a professor of obstetrics and gynecology at Eastern Virginia Medical School.

The first step is to rule out underlying conditions that may be causing the excessive bleeding, Archer and others agree. Among the possibilities, besides uterine fibroids, are endometriosis -- growth outside the uterus of endometrial tissue that normally lines the uterus -- and abnormally low thyroid function.

A doctor should also make sure the bleeding isn't due to a condition in which the woman is not ovulating, Archer said.

Among the options for women who are ovulating and aren't found to have an underlying medical condition are the use of birth-control pills, nonsteroidal anti-inflammatory drugs, as well as insertion of an intrauterine device, Archer said.

Research on the treatments suggests that none helps all the time, and all are associated with some side effects, he said.

Archer said he's preparing to study more closely the use of the Mirena levonorgestrel-releasing intrauterine system, in a clinical trial funded by the manufacturer.

SOURCES: David F. Archer, M.D., professor, obstetrics and gynecology, Eastern Virginia University Medical School, Norfolk; Elizabeth Battaglino Cahill, R.N., executive vice president, National Women's Health Resource Center, Red Bank, N.J.