Mas

By: Lauren Helper/MÁS staff

Description: Relief in sight for women with problem periods

Your “friend” has become your enemy. Your “monthly visitor” has overstayed its welcome. The “crimson tide” has become a tidal wave.

One in five — or 10 million — American women suffer from excessive menstrual bleeding, or menorrhagia. Consequences can include severe pain, fatigue, embarrassment and iron-deficiency anemia.

If you’re one of these women, you may have to wear a tampon and pad for double protection. You may carry a change of clothes due to heavy bleeding. You may have missed work and avoid traveling or leaving home when menstruating.
You probably want your life back. Period.

Dr. Jason Helliwell, a local OB/GYN with Advanced Women’s Health Center, says heavy bleeding is not a problem women should accept. Treatment options include hormones, dilation and curettage (D&C), hysterectomy and a widely available alternative treatment that Helliwell also offers — endometrial ablation.

But before you can be treated, you have to speak up.

According to a survey conducted by the National Women’s Health Resource Center, most affected women (58 percent) have not discussed their condition with a healthcare provider. Hispanic women in particular are much less likely to seek aid or treatment for their problem periods.

Helliwell guesses it’s a cultural issue.

“Traditionally, Hispanic women may not be as exposed to — or have access to — healthcare,” said Helliwell, who said the problem could also be lack of insurance.

Or it could just be a “grin-and-bear-it” stoic outlook inherited from generations of tough matriarchs.

“Grandma might just say, ‘That’s life,’” said Helliwell.

Helliwell said many women try to manage the situation with more rest and over-the-counter medications, but still suffer debilitating effects from the condition.
He added it’s critical that they and their health care provider discuss menstruation as part of a routine physical exam, and begin a dialogue about the under-diagnosed condition.

Helliwell sat down with MÁS to discuss diagnosis, causes, and treatment options for heavy periods:

Determining heavy bleeding
Normal periods can vary from one woman to the next. But generally, 4 to 12 tablespoons of blood are lost; bleeding occurs every 24 to 31 days; and bleeding lasts four to seven days.

According to Helliwell, there are two methods for determining if you suffer from heavy bleeding: quantitative and symptomatic.

A symptomatic diagnosis can be reached if a patient says her periods are interfering with her everyday life and restricting day-to-day activities. Women may feel their job performance is diminished due to frequent restroom breaks, and report that problem periods compromise their sex life. Heavy bleeding may cause a woman to limit activities, and cause fatigue or anemia.

A quantitative diagnosis may be reached if periods last for a long time (more than seven days); bleeding is so heavy you need to change protection frequently; and you lose more than 80 milliliters or more of blood per cycle (about a third of a cup).

Possible causes
According to Helliwell, there are many potential causes for heavy periods, such as hormone imbalances, fibroids and polyps, infections and bleeding disorders.

• Hormonal imbalances
Hormonal imbalances occur when a woman is not producing the right balance of estrogen and progesterone. They are common, especially when a woman begins or ends her reproductive years. This imbalance may also be caused by the wrong combination of hormone therapy.

• Fibroids and Polyps
Fibroids and polyps are abnormal growths or tumors inside the uterus. These may be removed if they are causing uncomfortable symptoms.

• Infections
Infections of the uterus or cervix can be serious and cause symptoms including excessive bleeding. Infections are commonly treated with antibiotics.

• Bleeding Disorders
Disorders that impair blood clotting (thickening of the blood to slow or stop its flow) are serious disorders that need medical attention.

High risk candidates for heavy periods
    • Women who are overweight
    • Women who have hormonal imbalances
    • Women who have never been pregnant
    • Women with thyroid problems or diabetes
    • Women over 35

Treatment options
When considering treatment options, Helliwell said a patient should consider several factors, such as whether or not you plan to have children in the future and whether you want ongoing therapy or a one-time treatment.

Options include endometrial ablation, hormones, dilation and curettage (D&C) and hysterectomy.

Hormones are usually the first line of treatment. Dilation (enlarging) and curettage (scraping) involves expanding or enlarging the entrance of a woman’s uterus so that a thin, sharp instrument can scrape or suction away the lining of the uterus and take tissue samples. The procedure is routine and considered safe, but only stops bleeding for two to six months. A hysterectomy — surgical removal of part or all of the uterus — requires significant recovery time.

NovaSure
Helliwell recommends the one-time NovaSure endometrial ablation procedure for many of his female patients who qualify.

The NovaSure procedure removes the lining of the uterus to control heavy bleeding, and only needs to be performed once.

1. Your doctor will slightly dilate the cervix and insert a slender wand through the cervix into the uterus.

2. The doctor then extends the triangular mesh array through the wand where it expands to conform to the dimensions of the uterine cavity.

3. Electromagnetic energy is then delivered into the uterus for approximately 90 seconds.

4. The triangular mesh array slowly retracts and the wand is gently removed from the uterus.

Helliwell said the NovaSure procedure can be done in the office, rather than a surgery center. Insurance typically covers the procedure because it’s a less expensive alternative to surgery, so patients only have to pay the office co-pay, he said.

While patients will be in the office for about an hour, the actual procedure takes two minutes or less.

Helliwell said he does about 100 endometrial ablations a year, and sees success — defined as either no bleeding or an improvement in the amount of bleeding — in about 80 percent of patients. The other 20 percent stayed the same or worsened.

Note: Pregnancy following endometrial ablation is very dangerous for both the mother and the fetus. You should not have an endometrial ablation if you think you want to have a baby in the future. After an endometrial ablation, you should use some form of birth control. Please discuss these issues with your physician.

Sylvia’s story
At 55, Sylvia Vallejos has suffered from heavier-than-normal periods since she was 14. About 25 years ago, she brought up the issue with her gynecologist, who brushed off her concerns.

“I got the impression that he thought it must just be in my head,” said Vallejos. “Like I was supposed to suffer as part of being a female.”

Vallejos was later put on hormones, which didn’t agree with her, and had a D&C.

Discouraged, Vallejos kept quiet about the issue until about a year ago, when the excessive bleeding became unmanageable.

“It was awful. I had to plan my life — work, weekend getaways, even one-day excursions — around my period. And I always carried an excess amount of sanitary products just in case.”

Vallejos made an appointment with a gynecologist, who suggested a hysterectomy. Nervous about having major surgery, Vallejos went in search of a second opinion, and made an appointment with Dr. Helliwell, who suggested the NovaSure option.

“I was excited. I wanted him to do it right then and there,” said Vallejos, who instead had to go through a series of tests to rule out cancer and other issues that would make the procedure ineffective, including a uteran biopsy, sonogram of the uterus, and hysteroscopy, which uses a hysteroscope, a thin telescope, inserted through the cervix into the uterus.

“Yes, I can say I’ve seen the inside of my uterus,” said Vallejos, laughing.

About a month after her initial visit to Helliwell, Vallejos went in for the procedure.

She describes the results in one word — “wonderful.”

While not totally free of periods, Vallejos only has one about every two months and it’s only a day of light spotting.

“There’s no bloating, no cramps — I can’t describe it. The freedom in wonderful. I feel almost normal,” said Vallejos.


More than 56 percent of women have to make adjustments to their daily lives because of heavy periods.

Among women with abnormally heavy menstrual periods:
• 85 percent feel tired and nauseated; 77 percent feel depressed or moody; 76 percent experience bad cramps; and 69 percent have headaches.
•  1 in 12 missed more than a week of work because of a heavy period.
•  50 percent have had to miss a party or an event because of their heavy period.
•  80 percent have avoided sexual activities because of their menstrual period.


— Additional information for this article was taken from: www.novasure.com