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Dec. 11--Dr. Marcus Gordon, gynecologist, New England Gynecological Associates, Methuen and Lynn
Explain what menorrhagia (men-or-ay-ZHA) is. How common is it?
It's a very common problem, particularly for women in their late 30s and 40s. Periods become heavy and irregular. Some women we see bleed 15, 20 days a month, or every two to three weeks (rather than the average 28 days). Some have a lot of clotting.
Why does it happen?
It's usually hormonal. Later in life, around 40, you don't ovulate regularly, there are fewer eggs and the quality of those eggs isn't the same, which causes an imbalance in the estrogen and progesterone cycle. The estrogen is what causes the lining of the uterus to proliferate; then the progesterone comes in. If you don't ovulate in a given cycle, you have unopposed estrogen. Excessive bleeding can have other causes, too -- fibroids (smooth muscle tumors in the uterus) are very common. Polyps also cause this.
Can you just ignore it?
It's a quality of life issue. I think most people are very frustrated when their menses are going on for that long. But the threshold is really how it interferes with your life. If you're soaking through pads so quickly that you can't leave your house, you should address it. Then there's the danger that, with anemia (from blood loss), you can faint and injure yourself. If it's severe enough, you have to worry about your heart. So conceivably it has all sorts of health consequences.
How do you diagnose menorrhagia?
The first thing is to rule out serious pathology. Endometrial cancer can present as abnormal bleeding, but that's extremely uncommon. We aspirate a little tissue from inside the uterus.
And the treatment?
The first line treatment has been to put them on hormones; sometimes you give both estrogen and progesterone. Another option is to give progesterone 10 or 12 days a month and try to regulate them that way. It often works, but they're not without side effects ... like bloating, fluid retention, some people are nauseated, and they don't always work.
Describe the surgical treatment.
It's called an endometrial ablation. You put the device into the uterus with the patient under local anesthetic, measure the length and width of the cavity and it delivers the appropriate energy to destroy the endometrial lining. Ninety-five percent of the women (who have this procedure) don't have a (subsequent) period at all. It takes 90 seconds to two minutes in our office; there's some cramping, but for most people it's well tolerated. It's become a reasonable first-line treatment once you've ruled out endometrial cancer and large fibroids.
Is it for everyone?
It's not something you should do if you're planning a pregnancy. (After this surgery) the lining of your uterus is not going to support a pregnancy.
What about the recovery?
It's very well tolerated. People walk out of the office 15 or 20 minutes later, go back to work the next day. Unlike other surgical procedures, they're back to their normal lives -- or better than what they're used to -- very quickly. You may have a little bit of discharge right after surgery, for a couple of weeks.
Do you have a question for the expert? E-mail Christine Phelan at cphelan@lowellsun.com.
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