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Heavy menstrual bleeding before the onset of menopause occasionally stops without drugs or surgery, a new UK study shows.
"Women should be informed of the chance of the heavy bleeding stopping on its own," so that they can decide for themselves whether to see a doctor or whether to wait and see what happens, said Dr Mark Shapley, a general practitioner and researcher at Keele University, who worked on the study.
Sixty-five percent of participants reported heavy menstrual bleeding at the outset of the study – about twice the rate that is typically reported in the general population. One in five of the women found the bleeding stopped without treatment for six months, but in only half of these did periods remain normal for two years.
These findings, published in the journal BJOG, suggest that heavy bleeding "comes and goes" in a significant number of premenopausal women, Shapley said.
Bleeding gets better with treatment
Heavy menstrual bleeding is marked by abnormally heavy or prolonged periods, with blood loss and cramping so severe that a woman is unable to maintain her usual activities.
The study "provides women for the first time with a measure of the likelihood that the bleeding will get better without being treated," Shapley said.
The study is based on data from more than 2,000 women aged 40 to 54 in North Staffordshire. They answered questions at the start of the study related to the heaviness of their periods, missed or skipped periods, time frame between periods, and use of doctors or nurses to treat the symptoms.
The researchers then asked them about the presence or absence of symptoms six, 12, 18 and 24 months later.
Older women got better without treatment
Women being treated for heavy menstrual bleeding were excluded from the study. These treatments range from hormone pills, intrauterine devices (IUDs) and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (marketed as Advil) or naproxen (marketed as Aleve), to surgical procedures such as hysterectomies.
Heavy bleeding stopped without treatment more frequently as women get older, the study found. Seventeen percent of women aged 40 to 44 got better without being treated; the rate jumped to 35% in women aged 50 to 54.
"I think this is a useful analysis of, really, whether we should be doing any hysterectomies (to treat heavy bleeding) at all, except in very serious cases," said Dr Michelle Warren, director of the Centre for Menopause, Hormonal Disorders and Women's Health at Columbia University Medical Centre, who was not involved in the study.
Approximately 460,000 inpatient hysterectomies were done in the United States in 2009, costing on average $7,900, according to the federal Agency for Healthcare Research and Quality. Potential complications from the surgery include infection, haemorrhage and damage to internal organs.
Heavy bleeding causes embarrassment
Heavy bleeding particularly affects African American women, Warren told Reuters Health.
"The bleeding tends to be worse if you have fibroids, and African Americans have a higher incidence of fibroids," she explained.
While describing the study as "very reassuring" for women, Warren cautioned against using it as evidence that the problem can be ignored.
Heavy bleeding causes embarrassment and distress, and may lead to anaemia – a condition in which a low red blood cell count results in fatigue, she said.
The study shows that "probably more women should ask for help at this time when they're bleeding that heavily without worrying about whether they will end up with a hysterectomy," Warren said.
(Aparna Narayanan, Reuters Health, March 2012)
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