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Many women with endometriosis experience abnormally heavy and prolonged menstrual periods — menorrhagia. What do you need to know about menorrhagia and its possible treatments?

Endometriosis, a chronic inflammatory disease in which the endometrium — the tissue that normally lines the uterus — grows within other reproductive organs and within the abdomen as well. Although the condition isn't rare, scientific understanding of its causes remains lacking.

Pain, often especially during menstrual periods and ovulation, are among its main symptoms. Interestingly, the severity of this pain isn't dependent on the severity of the condition — women with few endometrial lesions can be in agony, while those with many may be relatively pain-free. Because women without endometriosis can also experience these things to a lesser degree, some women who turn to their doctor for help and diagnosis have their symptoms dismissed as "perfectly normal". In addition to pain, many women with endometriosis suffer from abnormally heavy periods, a phenomenon known as menorrhagia.

Nightmare periods: are they a sure sign you have endometriosis?

Women without endometriosis can have menorrhagia, while many — but by no means all — women with endometriosis have these heavy "nightmare" periods. Though endometriosis patients often suffer not just from very heavy and prolonged menstrual bleeding but also observe large clots in their menstrual flow, some sufferers actually have mild and short periods. 

Having abnormally heavy periods isn't a sure sign that you have endometriosis, then. Menorrhagia is closely linked to a related condition called adenomyosis, in which endometrial tissues infiltrate the muscular wall of the uterus, on the other hand. 

So, how do you know if you have menorrhagia?

  • You lose more than 80 milliliters of menstrual fluids over the course of a period.
  • Your period will usually last for a long time — more than a week.
  • You may pass large clots. 
  • You are likely to have iron-deficiency anemia because of your heavy blood loss. 

You usually won't know the exact volume of your menstrual flow, of course, but if this sounds familiar to you, consult your doctor for diagnostic tests to determine whether your period is abnormally heavy.

How is endometriosis typically managed?

If you are not looking to get pregnant, your treatment plan is likely to involve:

  • Painkillers to reduce your discomfort, either over the counter or prescription.
  • Hormone therapy can work very well for women with milder endometriosis. Birth control pills and other forms of hormonal contraception are often advised, but you may also be prescribed non-contraceptive hormones — progesterone, danocrine or gonadatropin-releasing hormone (GnRH). Hormone therapy will almost certainly reduce the volume of your menstrual flow.
  • Surgery can be performed to remove endometrial lesions, but in extreme cases, a hysterectomy may be the last-resort treatment of choice. Surgery is considered in women with severe endometriosis and/or those who experience a lot of pain.

How is menorrhagia treated?

Menorrhagia can be treated with:

  • Combined hormonal contraceptives — these contain both estrogen and progesterone. 
  • Progesterone-only medication, either designed as a contraceptive (like Nor–QD or Camilla, which are pills, or the Mirena intrauterine system) or for other reasons (norethindrone acetate/Aygestin). If you take Aygestin, your dose will be tailored to your needs.
  • GnRH agonist, for example leuprolide acetate (Lupron–Depot) can put a temporary stop to your menstrual periods. It lowers estrogen levels, which is good news for people with endometriosis as the condition is estrogen-dependent.
  • Tranexamic acid will greatly reduce the volume of your menstrual flow, and it is non-hormonal.

Can surgery stop heavy periods?

Yes, surgical options are available to combat severe menorrhagia that interferes with your quality of life. 

Endometrial ablation

An endometrial ablation destroys the endometrium, either by using laser, heat, or radiofrequency. It is an effective way to put a stop to excessive menstrual bleeding, but because becoming pregnant after undergoing the procedure is very risky, it is only suitable for women who do not want to become pregnant ever (again). Women often undergo a tubal ligation at the same time to prevent pregnancy permanently.

Endometrial resection

An endometrial resection is another procedure that removes the endometrium, resulting in much lighter periods. Again, it is suitable for women who are not planning to get pregnant, not just in the near future but at all. 

Hysterectomy

A hysterectomy may sound like a radical solution, and it's usually performed only as a last resort. It does, however, save you from periods forever and immediately. Some women with endometriosis have their fallopian tubes and ovaries removed at the same thing, which induces menopause.

Uterine artery embolization is another surgery that is most commonly performed to treat uterine fibroids. By reducing the blood flow to the uterus, it can put a stop to heavy menstrual bleeding as well. More research is needed to determine whether it is safe to get pregnant following this procedure, but some women have had babies after undergoing a uterine artery embolization. Resonance-guided focused ultrasound is another option currently being explored, with current results indicating that this has real potential in treating heavy periods.

How can you treat menorrhagia-related anemia?

Menorrhagia can lead to blood loss that is heavy enough that it reduces your red blood cell count, resulting in anemia. Lab tests can diagnose anemia, but you may recognize the symptoms and talk to your doctor about your iron levels:

  • Fatigue
  • A general feeling of weakness
  • Pale skin

Though iron supplements and dietary changes can help replenish your lost iron, the ultimate answer lies in treating your menorrhagia.

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