Medicine cabinet

Q: I'm a 39-year-old female. In the past three to four months, I've been experiencing changes in my menstrual cycle marked by excessive bleeding and

clotting.

A: The best way to treat excessive or prolonged menstrual bleeding depends on the cause. Excessive or prolonged menstrual bleeding is called menorrhagia. It is difficult to measure the actual amount of blood lost during a period so the diagnosis is usually made by assessing the menstrual symptoms.

They include:

n Needing to change a pad more often than every 3 hours during the day or needing to change a pad during the night

nSoaking through both a tampon and pad

nPassing large blood clots

nFeeling fatigue and other symptoms of anemia

Three main types of conditions cause menorrhagia:

n Hormone imbalance

nUterine growth (such as a fibroid or polyp)

n Bleeding disorders

Menorrhagia due to hormone imbalance can be treated with medicines or surgery. Which one to choose depends on the patient's age, preference, plans for pregnancy and medical condition. Oral contraceptive pills - or pills or injections that contain progesterone only - often are effective. There's also an intrauterine device that contains progesterone. It's effective, reversible and usually well tolerated. It can be placed during an office visit.

Bleeding from a growth is often best treated by removing the abnormal tissue from the uterine cavity.

Bleeding disorders are rare. They may require specific therapies, but the resulting menorrhagia can often be treated like a hormone imbalance.

Ablation of the endometrium is the surgical destruction of the inner layer of the uterus. This layer produces the menstrual flow.

Ablation can be done by:

n Freezing (cryoablation)

n Cautery (thermoablation)

The procedure usually requires anesthesia or sedation for pain control. Many women have cramping and discharge for several days afterward. Ablation is not for anyone who might want to get pregnant someday.

Hysterectomy is the surgical removal of the uterus. It is the most definitive way to treat menorrhagia. This, however, is major surgery and results in permanent sterility.

Today's Medicine Cabinet was written by Joan Marie Bengtson, M.D., assistant professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School and a member of the Department of Obstetrics, Gynecology and Reproduction at Brigham and Women's Hospital, Boston, Mass. For additional consumer health information, visit health.harvard.edu.