Usually hormonal problems are at the root of heavy menstrual bleeding. If you did not ovulate (often the case with young girls and women near menopause), there may not be enough progesterone in the right place at the right time to keep menstrual bleeding in check. You may have heavy bleeding. Occasionally, problems with thyroid, adrenal, or pituitary hormones may result in an imbalance that can cause heavy periods.

Can you do anything to lighten heavy periods?

Once you and your doctor have ruled out the possibility of disease, you can try birth control pills, since most women who use them have fairly light periods.

If your heavy periods are caused by ovulatory problems, you can try progesterone therapy, which simply provides “outside” progesterone to make up for what your body is not producing. Doctors often recommend medroxyprogesterone, a synthetic progesterone sold as Provera. The dosage is usually 10 mg daily for ten to twelve days.

Sarah usually goes about thirty-eight days, more than five weeks, without a period and then bleeds heavily. To get her heavy bleeding under control, we decided that she should take progesterone in pill form beginning on day 16 of her cycle and continuing for ten or twelve days each month. The progesterone stabilizes the lining of her uterus and prevents the tremendous overgrowth during the second half of her cycle that was causing her heavy bleeding. When she stops the progesterone, she gets a clean-out bleed of moderate volume, controlled by the progesterone. The progesterone therapy works for her, because low progesterone was the cause of her heavy bleeding.

This treatment does not always work. Sometimes when I look under the microscope at a sample of endometrial tissue, I see that different parts of the sample look like tissue from different parts of the menstrual cycle. Some parts look as if they come from the first week in the cycle, some from later. So at any one time some of this tissue is bleeding.

If progesterone therapy does not work for you, your doctor may suggest therapy with birth control pills, which contain both progesterone and estrogen, in the hope that adding back some estrogen will “get the cycle together.” That is, it will get all the tissue in the endometrium on the same schedule. Here is the “magic” schedule for birth control therapy: four birth control pills a day for three days, then three birth control pills a day for three more days. That comes to twenty-one pills, a whole cycle’s worth of pills in six days. After that, you break into your next pack of pills and take two pills a day for three more days, and then one pill a day until the second pack is gone. When you have finished the second pack, you should have a controlled withdrawal bleed, not a flow that resembles Niagara Falls!

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