Stopping Excessive Menstrual Bleeding

The intrauterine device called Mirena (search) does an equally good job of reducing heavy and prolonged menstrual bleeding as surgery, say Finnish and Norwegian scientists.

Heavy or prolonged periods are common, prompting 5 percent of gynecological visits by women in their 30s and 40s.

Finding solutions can be tough. Medications like birth control pills to control excess bleeding aren’t always the right long-term answer, say the researchers, noting that some women don’t take the oral contraceptives faithfully and side effects can be “unacceptable.”

Surgery provides other options. Hysterectomy — removing the uterus — is the most drastic tactic. An alternative technique removes only the uterine lining. But surgery requires hospitalization and anesthesia, making it expensive. The procedures aren’t appropriate for women who may want to get pregnant later on. Like any surgery, complications can arise, although the risk is lower with experienced practitioners.

Mirena, the intrauterine device (search), takes a different approach. It releases a hormone called levonorgestrel, which can reduce menstrual bleeding by as much as 80-96 percent over a year with few negative side effects, say the researchers.

Which approach works best? To find out, Rauramo and colleagues compared Mirena with the surgery that removes the uterine lining. Thirty women used Mirena and 29 had the surgery.

For three years, participants got gynecological exams and reported how many pads and tampons they used during their periods. They also scored the degree of menstrual bleeding based on pictorial comparisons and kept diaries of any bleeding throughout the study.

Mirena and surgery were equally effective at reducing menstrual bleeding in women who completed the study (19 women from the Mirena group and 22 surgical patients).

Within the first 90 days, women who received the Mirena IUD reported an average of 25 days of bleeding, while women who underwent surgery reported an average of 12 days.

Women who got Mirena reported 11, 1.5, and 0 days of bleeding on average during the first, second, and third year, respectively.

Women who had surgery reported no bleeding after 90 days.

Mirena had several advantages, say the researchers. It’s easily implanted by health care providers and offers birth control protection. Levonorgestrel (search) makes cervical mucus thick and sticky enough to stop sperm from reaching the uterus. The hormone may also prevent the implantation of fertilized eggs.

Side effects with Mirena include cramps, back pain, headache, nausea, acne, breast tenderness, and mood changes.

Mirena must be removed after five years. But your health care provider can insert a new Mirena immediately during the same visit if you want to continue using Mirena.

The study was funded by the German company Schering AG, Mirena’s maker. Rauramo was employed by Schering AG during the study, and another scientist involved in the study now works for the company, says the journal.

Women with heavy menstrual periods may want to keep a few other tips in mind. Those who have always had heavy periods could benefit by checking their blood’s iron levels every six months. Heavy menstrual flow is the leading cause of anemia (low iron) in young women.

If periods suddenly become heavy, women might want to consult their health care provider. There may be nothing to worry about, but an expert could rule out fibroids, tumors, or other problems.

By Miranda Hitti, reviewed by Brunilda Nazario, MD

SOURCES: Rauramo, I. Obstetrics & Gynecology, December 2004; vol 104: pp 1314-1321. WebMD Medical Reference from Healthwise: “Intrauterine device (IUD) for Birth Control.” WebMD Medical Reference from the Gynecological Sourcebook: “Menstrual Health.” Reuters Health. Berlex Inc.