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ASK Heavy Menstrual Bleeding:




Call the doctor! If you feel faint or there is blood flowing out of the vagina, filling the toilet or on the floor, call 911 (Emergency!)Usually, the heavy menses is not cancer! Most women, will have irregular or missed menstrual periods: when they start to menstruate again, under stress, with the oral contraceptive or IUD, after childbirth and in the pre-menopause, some of these menstrual periods can be quite heavy. A rule is if you are using more than one tampon per hour, it is too heavy so call the doctor.

The B.E.S.T. answer is if you are asking the question, and you donot need the 9111 service, is then you should have an appointment with a physician/ healthcare professional who is able to explain your anatomy, your questions, perform an examination, and offer you a medical treatment should a period of observation not bring a satisfactory conclusion.

How Do I Find Out for Sure that I do not have cancer?

There are four procedures that a gynecologist can order/perform that will alleviate the concerns of a pre-menopausal or menopausal woman with irregular bleeding; or any woman with heavy menses that may cause anemia:
(1) The experience of the gynecologist is key here. He/she has years of experience. So while the other health assistant may take your history, insist on the top professional for his/her opinion before getting sent to the procedures listed below.
*The physician may determine that a one, two or a few cycles of specific oral contraceptives can regular the menses in a younger woman and calm her concerns. For 40 years, my favorite oral contraceptive was Lo-Estrin® 1/20 but today many women prefer an even lower dose estrogen pill called Yaz®.
* In women with heavier cycles, the synthetic MPA (Provera 10mg) is used. The Editor uses the MPA to stop the heavier flow for 20 days; stop for 10; and then repeat the cycle. This should significantly reduce menstrual flow and can be used equally well in the pre- and menopausal woman.
*The key to remember is that there is an in-office definitive procedure where a suction D&C (dilatation and curettage) is performed. This will remove the bleeding tissue, cause the blood vessels to spasm and usually stop the heavy bleeding. The tissue is sent to a pathologist to confirm that there is no cancer.
(2) Pelvic ultrasound. Once the bleeding is controlled, pelvic ultrasound is used to confirm if there are masses in the uterus called leiomyomata (fibroids). These can cause bleeding by distorting and stretching the endometrium lining; then, causing bleeding. The pelvic ultrasound can confirm the thickness of the endometrial lining, In older women, a thickness of greater than 5mm warrants the endometrial biopsy. Gynecologist are taught that there is little risk of cancer if the endometrial thickness is less than 5mmg. Thirdly, the pelvic ultrasound can detect ovarian tumors, cysts and potential ovarian cancer.A negative ultrasound is comforting.
(3) If the gynecologist is concerned that there is a leiomyomata in the uterus, he may use an office hysteroscope (to 'scope'/look into) the uterus. This would be performed to determine if the procedure could be completed in the office. Another procedure can fill the uterus with a balloon of water to better visualize any polyps or fibroids by ultrasound.The second procedure might stop the bleeding temporarily.
(4) If the bleeding is mild, the B.E.S.T. procedural test is an in-office endometrial pathological biopsy. This is smaller and less painful than an in-office D&C. The tissue specimen is also analyzed by a pathologist.

(5). If the bleeding is profuse, the doctor can start in intravenous line and slowly inject Premarin® over 10-20 minutes. The high dose of estrogen stabilizes the uterine bleeding. Once stable, the next step would normally be an in-hospital dilatation and curettage to stop the bleeding, remove the tissue and rule out cancer. Most office procedures cost a few hundred dollars; the hospital emergency room and operating room can cost $2000 to $4000.

(5\6) With operative hysteroscopy, the trained gynecologists can remove some leiomyomata, polyps and burn down the endometrium (called an endometrial ablation). Sometimes, this can be performed in the doctor's office or in the hospital at a cost of approximately $3000. The failure rate depends: approximately 50% of women are satisfied, but 50% still have some, albeit, less uterine bleeding.
Definitive Treatment
(1) Most older physicians know that danazol, a weak androgen, has been used for more than 50 years to treat the bleeding and pain associated with endometriosis. The mistake was then to use the full dose of 200mg 4 times per day. We now know that 100 mg 2 to 3 time per day works as well. The Editor adds 100mg of spirolactone to avoid any hirsuitism and 25mg of pregnenolone for any fatigue in the morning. The Editor cycles danazol on for 25 days and stops it for 3 to see if a menses will occur. The Cochrane Database termed Danazol the most superior treatment for irregular to heavy menstrual bleeding.

Avoiding hysterectomies. The section on Avoiding Hysterectomies takes the concept of Danazol one step further. The uterine lining cells have receptors that are called Androgen-Receptors (A-R). They hook up with testosterone, estrogen and progesterone. The affinity for testosterone is 98%; for estrogen 90% and progesterone much less. The key is that testosterone is 10x more likely to plug up the A-R receptor. So the Editor uses tiny doses of three natural testosterone(s) in the woman's body to block the A-R receptor from making the lining grow. The result is no menstrual period; the inner lining of the uterus looks "as dry as a bone." The medication is very inexpensive, stops hot flashes, builds bones and muscles, and can sometimes shrink fibroids and sto the pain of endometriosis for a large number of women. The result: a woman can feel better without having her organs castrated by hysterectomy and removal of her ovaries; no results can be guaranteed for everyone. Only if the mixed androgens fails does the woman need to discuss or risk hysterectomy. Maybe, half of the 400,000 hysterectomies for bleeding can be avoided.

The laboratory tests for ANEMIA can be ordered on this site for less than two-hundred dollars without a doctor's request or insurance.

1. Normal 1ab blood cell count; iron; ferritin values
2. Pituitary FSH and LH instruct the ovaires to make estrogen. Normal values are less than 10-20 miu/L; over 20 is typical for menopause.
3. Total estradiol should be greaeter than 50 normally and less than 20 pg/ml in the menopause.
4. Progesterone levels at 15 pg/ml are typical of ovulation on the 23rd day. They are inaccurate at other times of the month.

If the red cell count is abnormal, you need to discuss this with a doctor who may prescribe iron. Intravenous iron is needed on occasion.

The mixed androgen injections are safe for women from their teens to their 80's; they are used to treat menopausal hot flashes in women with breast cancer,pain with severe endometriosis, and to maintain good libido, bone and skin conditions in aging. See the Endometriosis Breakthough Movie


1. Lysteda® /tranexamic acid
There has been a recent move away from danazol to an expensive Lysteda® non-steroidal anti-inflammatory agent. The nonsurgical management of heavy menstrual bleeding in 2013 prefers levonorgestrel IUD over oral contraceptives, progestins (MPA) in the second half of the cycle, and NSAIDs. The Editor agrees to using these but after the danazol has thinned the endometrial lining for better results.

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