What is "Excessive" Menstrual Bleeding?

You are different from every other woman, and so, probably, are your periods.  When it comes to periods, there is a wide range of normal.  Generally, the average period lasts 5-7 days.  On the other hand, if you suffer from heavy periods, you probably know what it's like to experience one or more of these difficult and disruptive symptoms:

• Menstrual flow that soaks through one or more tampons or napkins every hour for several consecutive hours
• Menstrual flow that interferes with your regular activities or lifestyle and causes anxiety about embarrassing accidents
• Periods that last longer than seven days
• Menstrual flow that includes large blood clots
• Fatigue or shortness of breath (which are symptoms of anemia caused by blood loss)

What Causes Heavy Periods?

There are a number of medical conditions that may cause or increase your chance of having heavy periods.  These include:

• Hormonal Imbalance- One of the most common causes of excessive menstrual bleeding is an imbalance of the female hormones estrogen and progesterone.  Among other things, these hormones regulate the thickening of the endometrium - the lining of the inside of the uterus that consists of tissue and that is shed each month during menstruation.  An imbalance of these hormones can cause the endometrium to thicken more than usual, causing menstrual bleeding to be heavier than normal.

In other cases, heavy bleeding may be due to:

• Fibroids- Usually benign (non-cancerous), fibrous growths in the uterus that can cause pressure and pain in addition to heavy periods.
• Polyps- Usually benign, fleshy growths on the lining of the uterus.
• Neoplasia- New tissue growth caused by anything from a simple thickening of uterine tissue to, in rare cases, a precancerous or cancerous condition.
• Blood Clotting Disorders- Conditions such as Von Willebrand's Disease that prevent the blood from clotting properly.

What else do I need to know?

There are other potential causes of heavy bleeding, such as cancer, certain medications (including those that prevent clotting of the blood), and other medical conditions.

It is important to talk with your doctor if you experience menstrual bleeding that is heavier than normal.  Before making a diagnosis, he or she will take a complete medical history, perhaps ask you to record your symptoms in a diary for one or more cycles, and may recommend other tests such as ultrasound, dilation and curettage (D&C) or endometrial biopsy (sampling of the endometrium), or hysteroscopy (looking into the uterus with a thin telescope).

What Treatments are Available to me?

It all depends on what is causing your heavy periods.  The best treatment option for you also depends on your overall health and the severity of your condition as well as its impact on your life, your goals for treatment, and your plans for the future, including pregnancy.

If your heavy periods are due to a hormonal imbalance, some of the treatment options include:

Procedure/description	Benefits/Effectiveness	Impact on Fertility	Side Effects/Drawbacks	Risks/Complications
Drug Therapy Medications- hormone therapy with oral contraceptives or Progesterone Often prescribed as a first step when attempting to bring heavy periods under control.	Can help regulate ovulation and reduce heavy or prolonged menstrual bleeding Can be effective in decreasing bleeding without the need for surgery	No effect on fertility when discontinued	Minor- Headaches, breast tenderness and weight gain are common.  Long-term use is often required.	Serious complications are rare
Dilation & Curettage (D&C) Surgical procedure in which doctor widens (dilates) opening of cervix and scrapes away tissue from the lining of the uterus (curettage).	Not a long-term solution for heavy periods because endometrium grows back Can result in reduction of heavy flow for next few cycles. Out-patient procedure.	Normally, no effect on fertility	Mild cramping, spotting or light bleeding. Potential complications associated with general anesthesia, if used.	Perforation or rupture of the wall of hte uterus. Infection and injury to the cervix.
Endometrial Ablation Surgical procedure that removes the endometrium (inner lining of the uterus). Very little of the endometrium grows back and heavy bleeding is much less likely to continue.	Minimally invasive one-time treatment. Periods either return to normal, are much lighter or stop completely. Often the only treatment you will need for bleeding. May be performed under local anesthesia.	Ablation treats the endometrium which is needed to carry a baby to full-term. Most women are not able to become pregnant but conception is still possible. Requires consistent use of contraception until menopause.	Mild cramping, pelvic pain and nausea, for a short time, after the procedure.	The following risks and complications are rare: Potential blood loss. Accidental puncture of the uterine wall or bowel. Potential complications associated with general anesthesia, if used. Any pregnancy may be risky for both you and the baby.
Hysterectomy Surgical removal of the uterus. Hysterectomy can be performed: Abdominally- through incision in lower abdomen. vaginally- through an incision on the top of the vagina near the cervix. laparoscopically- through tiny incisions using small laparascopic instruments.	Will cure heavy bleeding and eliminate periods altogether	Because the uterus is removed completely, you can no longer become pregnant.	Major surgery- must be performed under either general or regional anesthesia. If ovaries are removed, onset of menopause in immediate. Hospital stay is required.	The following risks and complications are rare: Potential blood loss, infections, and damage to other internal organs.

THERMACHOICE: Taking Control of Heavy Periods.

What is GYNECARE THERMACHOICE Uterine Balloon Therapy?

GYNECARE THERMACHOICE Uterine Balloon Therapy is a product used in one method of endometrial ablation for women who have not yet gone through menopause.  It is a simple, minimally-invasive 30-minutesprocedure that requires no hospital stay.  The procedure uses heat to treat the endometrium. It can be performed by your doctor under local anesthesia, and no incisions are necessary.  Unlike a hysterectomy, THERMACHOICE allows you to retain your uterus.

Here's how THERMACHOICE works, step by step:

1. A soft, flexible balloon attached to a thin catheter (tube) is first passed through the vagina and cervix, and then placed gently into the uterus.  No incision is required.   The balloon is made of silicon material, which eliminates the risk of allergy for latex sensitive women.
2. Fluid is then inserted into the balloon so that the balloon inflates to the size and shape of the uterus.
3. The fluid is heated and circulated in the uterus for eight minutes while the lining of the uterus is treated.
4. When the treatment is completed, all the fluid is withdrawn from the balloon, and the balloon is removed.  Nothing remains in the uterus.  The treated uterine lining will slough off, or shed, like a period, over the next 7 to 10 days.

Q. Is THERMACHOICE right for me?

A. THERMACHOICE is likely to be a good choice for you if your doctor has rule out uterine conditions such as fibroids or polyps as a cause of your heavy bleeding, if your Pap smear and biopsy (a tissue sample from inside the uterus) are also normal, and if you have not yet gone through menopause but are through with childbearing.

This is not a treatment for uterine cancer or precancerous conditions.

Q. What can I expect fro THERMACOICE?

A.  Studies show that THERMACHOICE is a safe and effective treatment for heavy periods.  Following treatment with THERMACOICE, most women (85%) can expect light to moderate periods, or possibly no period at all.  Recovery is fast.  Most women return to normal activities the next day.

Q. What will I feel during the procedure?

A.  Before treatment, your doctor may give you medicine to reduce cramping during and after the procedure, although you may still feel some.  You may also be given a mild sedative to help you relax, and your doctor may use local anesthesia to numb the cervix.  You are not likely to feel any sensation of heat as the fluid circulates in the balloon.

The procedure can be performed under local or regional anesthesia.  Some women and their doctors decide to have the procedure performed under general anesthesia. 

Q. What will I feel after the procedure?

A.  You may feel some cramping, as with a period.  If you need it, your doctor may suggest an anti-inflammatory pain reliever such as ibuprofen (e.g., Motrin or other medications) to make you feel more comfortable.  You should be ready to go home the same day and rest.

Q. What can I expect after I go home?

A.  Most women can go back to work and family commitments the day after their procedure.  Sexual activity can usually be resumed after your first check-up (usually in 7-14 days).  You will probably have a pinkish, watery vaginal discharge for about 2 weeks after the procedure, which is a normal part of the healing process.  In some cases, your first few periods after treatment may still be heavy, but they should begin to improve after that.

Once healing is complete, most women experience an average of 86% reduction in the amount of menstrual flow.  You might have light or moderate periods, or you might have no periods at all.

Q. What are the risks?

A.  All surgical procedures present risks.  Talk to your doctor to determine whether GYNECARE THERMACHOICE uterine Balloon Therapy is right for you.

Q. Will I still be able to have children after treatment?

A.  As with all endometrial ablation procedures, this procedure should not be used if you think you might want to become pregnant in the future.  Pregnancy after ablation is unlikely, but if it does occur, it may be risky for you and your baby because the endometrial lining of the uterus has been removed.  Since there is still a small chance pregnancy could occur, it is very important to use birth control correctly and consistently after any endometrial ablation procedure.

Q. Are women satisfied with the results of THERMACHOICE?

A.  Yes, they are.  In fact, when women were surveyed 5 years after their procedure for a recent study, 93% of women reported they were still happy with the results provided by THERMACHOICE.  Although other endometrial ablation products have recently become available, only THERMACHOICE has proven track record and 5 years of success and only THERMACHOICE has been used to treat over 175,000 women.

DO YOU HAVE HEAVY PERIODS?

1. Do you rearrange social events or daily activities around your period?
2. Do your tampons or sanitary napkins quickly become soaked and need to be changed frequently?
3. Do you often experience heavy bleeding with clotting?
4. Do you have a heavy period, even while using birth control pills?
5. Are you exceptionally tired or weak during your period?
6. Have you missed work because of your period?
7. Do you tend to stay home when you have your period because it's easier?
8. To be prepared, do you carry large quantities of feminine products or even a change of clothes?