Treating heavy bleeding during menopause

Q: My mother, age 53, has been experiencing heavy bleeding that is lasting for more than a week at a time. She has been to the ER twice in as many months to seek help and has at least one D and C done. Her Family Practitioner assures her that this is all part of menopause and that it will soon pass. But I see Mom getting weaker and no signs of improvement. She has seen an Ob/Gyn who did put her on a certain medication (sorry I can’t remember the name of it) that is often given postpartum for bleeding; it did nothing but raise her blood pressure. I am concerned and tried to find some info for her here on the Internet but I find nothing about excessive bleeding anywhere, especially not related to menopause. Is there something else I can do for Mom? Should she be seeing someone else? Thanks for you time.

A: Many women do get heavy periods associated with menopause. From a hormonal point of view, what happens is that even before we stop making estrogen the ovaries stop producing a good amount of progesterone – because we stop ovulating well. Progesterone is the policeman of the uterus – it limits the buildup of the lining of the uterus, and it controls periods.

From your description, I believe they gave your mother Methergine, which contracts the smooth muscles of the uterus, and occasionally does help bleeding ( it is given to women after they deliver babies). However, it sounds like she would do better with some progesterone, given to her daily for 12 or so days before her period, and continuing through her period. If she is a non-smoker, she also could well benefit from low-dose birth control pills, which really can work well in this situation, with minimal side effects.

If hormonal approaches do not work, she might have something like a small fibroid sticking into the uterine cavity. A simple procedure called hysteroscopy, similar to a D and C, could be done to see if she has one. If so, it could be removed using a gadget called a resectoscope.

Also, if she has not had her blood count checked recently, ask her to have it done. She may need some iron, and it’s better for her to build up her own blood than to have a transfusion. Of course, the bottom line is a hysterectomy – but I’ll bet one of these schemes will work before that becomes necessary.

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