Heavy periods may seem normal to you, but it’s important to know that’s not necessarily true. They’re often caused by uterine fibroids. These fibroids don’t cause cancer, but they can cause heavy periods and painful menstrual cramps, and may even make it harder to get pregnant. They can develop in women of any age but usually occur between the ages of 35 and 49. Fibroids often go away on their own after menopause, but in the meantime, many women either go untreated or are treated with a hysterectomy (removal of the uterus). This is an aggressive approach that may not be necessary. New menstruation medication and less invasive procedures are available to stop heavy periods that interfere with your life while keeping the uterus intact. Know your options.
Uterine Fibroids and Heavy Periods: What’s Considered Heavy?
If you lose more than a third of a cup of blood during your period for two periods or more, it’s considered heavy menstrual bleeding. The medical term is menorrhagia. This level of bleeding likely disrupts your normal activities. Signs are:
- Having to change tampons or pads every hour for several hours
- Needing to change tampons or pads during the night
- Blood clots bigger than a quarter
- Severe menstrual cramps
- Periods that last longer than a week
With heavy periods, anemia is also a concern. If you’re anemic, that means you’ve lost too many red blood cells. Symptoms include fatigue, weakness, and shortness of breath.
Diagnosing Menstrual Pain
Most women have menstrual pain, also called dysmenorrhea, for a day or two at the beginning of each cycle. The pain is usually mild. If it’s severe for you or lasts for more than a couple of days, it may be caused by uterine fibroids. You don’t have to just tough it out. Your obstetrician/gynecologist (Ob/Gyn) can confirm that your pain is in the abnormal range through a pelvic exam, ultrasound, or a minimally invasive laparoscopy procedure, then develop a treatment plan.
Treating Menstrual Pain: Menstrual Medication and More
Menstrual pain can be treated with medicine, hormones, surgery, or embolization. Your Ob/Gyn may suggest nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin IB) and naproxen (Aleve, Anaprox DS). If these haven’t worked for you in the past or your body can’t tolerate them, your doctor may recommend a new medicine called Oriahnn, which combines three hormones (elagolix, estradiol, and norethindrone acetate) into one capsule. It’s an oral prescription medication approved by the U.S. Food and Drug Administration (FDA) in 2020 for the management of heavy menstrual bleeding related to uterine fibroids in women who haven’t gone through menopause yet. It’s not recommended for women who are trying to get pregnant.
Some women who aren’t trying to get pregnant find relief from birth control that contains both estrogen and progestin hormones. It can be taken orally or given through a patch, injection, or intrauterine device (IUD).
Surgery should only be considered if other options don’t work for you. One type of surgery removes the fibroids, but not the uterus. It’s called a myomectomy and can be performed as a traditional surgery or less invasive laparoscopy. With a myomectomy, it’s possible your fibroids could grow back or you won’t be able to have a vaginal birth. Unlike a myomectomy, a hysterectomy removes the entire uterus, causing menopause and making it impossible to give birth.
Instead of surgery, some women opt for uterine fibroid embolization (UFE). It’s a non-surgical, minimally invasive procedure performed by an interventional radiologist to shrink the size of fibroids and reduce bleeding. Research shows that symptoms improve dramatically or completely go away for about 90% of women who have UFE. It’s not yet known to what extent UFE may affect fertility or cause pregnancy complications.
Every treatment has benefits and risks. Take the time to weigh them carefully with your doctor, considering the effect heavy periods have on your wellbeing, work and social life each month and your family planning goals.
