Should I treat dysfunctional uterine bleeding with bio-identical progesterone?
This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
See your health professional about heavy vaginal bleeding to make sure that a serious medical condition is not causing the bleeding. If a serious cause is ruled out, your condition is considered dysfunctional uterine bleeding, which can be treated with non-steroidal anti-inflammatory drug (NSAID) therapy, bioidentical progesterone therapy, synthetic hormones progestin’s or a surgical procedure.
Consider the following when making your decision about using hormone therapy for dysfunctional uterine bleeding:
What is dysfunctional uterine bleeding?
- Treatment can regulate, reduce, or eliminate menstrual bleeding. You may have to try more than one type of treatment before you find one that works for you.
- Non-steroidal anti-inflammatory drugs (NSAIDs) are often used first. If NSAID therapy isn't effective enough, you may add or substitute a therapy, such as the levonorgestrel IUD, progesterone, or a birth control (progestin and estrogen) pill/synthetic hormone. Combining NSAID and hormone therapy often improves their effectiveness.
- If you smoke, you should not take the estrogen-progestin birth control pill because of the increased risk for blood clots (thromboembolism) and high blood pressure. Progestin-only therapy and the levonorgestrel IUD do not carry these risks. Smoking while taking the estrogen-progestin birth control pill increases the risk for blood clots (thromboembolism) and high blood pressure (progestin therapy and the levonorgestrel IUD do not carry these risks).
- If you have no pregnancy plans, you can consider a surgical procedure instead, such as endometrial ablation or hysterectomy.
- Unless you have anemia from heavy blood loss, you can choose watchful waiting and no treatment. If you are approaching menopause, you can look forward to a natural end to menstrual bleeding. If you are a young woman, your cycles are likely to even out and lighten as your body matures.
Dysfunctional uterine bleeding is heavy menstrual bleeding that isn't caused by a serious condition such as disease or a pregnancy complication. It is usually caused by hormone imbalances that interfere with regular ovulation and the menstrual cycle, but it can also be a problem of unknown cause in women who ovulate. Dysfunctional uterine bleeding is most common among during the teen and perimenopausal years, when reproductive hormones tend to fluctuate.
You may have dysfunctional uterine bleeding if you have one or more of the following symptoms:
These symptoms can also be signs of a serious medical problem. If you have the above symptoms, your health professional must check for all serious causes of abnormal vaginal bleeding, such as miscarriage or disease, before concluding that you simply have heavy menstrual bleeding.
- Menstrual bleeding that occurs more often than every 21 days (a normal menstrual cycle is 24 to 35 days long)
- Menstrual bleeding that lasts longer than 7 days (normally 4 to 6 days)
- Blood loss of more than 80 mL each menstrual cycle (normally about 30 mL). If you are passing large clots or soaking a large pad per hour for 8 hours, your bleeding is considered heavy.
What are the risks of dysfunctional uterine bleeding?
Heavy uterine bleeding can lead to anemia, causing weakness, pale skin, and general tiredness (fatigue). In cases of severe uterine bleeding, blood transfusion is used to quickly restore needed blood volume.
Over time, heavy, irregular uterine bleeding can make it difficult to have an active life. Irregular, heavy bleeding can interfere with daily living and sports activities, as well as sexual relations.
How is dysfunctional uterine bleeding treated?
A number of treatment options are available for heavy uterine bleeding that has no serious cause (dysfunctional uterine bleeding). While some are meant to return the menstrual cycle to normal, others are used to reduce bleeding or to eliminate menstruation. Each of these options works well for some women, but not others.
- Watchful waiting for a teen or a woman approaching menopause. Menstrual cycles usually even out and lighten as a teen matures; they end at menopause.
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. NSAIDs reduce high levels of prostaglandins, which are linked to heavy uterine bleeding. Women with very heavy bleeding are likely to gain the greatest benefit from NSAID therapy.
- Hormone treatment. The levonorgestrel IUD releases a synthetic form of the hormone progesterone into the uterus. This reduces bleeding while preventing pregnancy.
- If you've been bleeding heavily because of low progesterone (needed for ovulation), a bioidentical natural progesterone can help you start ovulating, build a healthy endometrium, and bleed normally.
- A birth control (progestin and estrogen) pill can help regulate your cycle, prevent ovulation, and reduce or stop menstrual bleeding. But this has side effects that you should consider and be aware of.
- Seldom-used medications that stop estrogen production and menstruation, such as gonadotropin-releasing hormone analogues (GnRH-As) or danazol. These medications aren't commonly used for long-term treatment because of severe side effects.
- Surgery, such as dilation and curettage (D&C) for short-term relief of severe bleeding or endometrial ablation for longer-term relief of bleeding. In uncontrollable cases of uterine bleeding, the uterus can be removed (hysterectomy.
- Early treatment with bio identical progesterone can regulate, reduce, or eliminate menstrual bleeding. You may have to adhere to a 3 to 6 month period.
If you need more information, see the topic Dysfunctional Uterine Bleeding.
Your treatment choices are:
- Use synthetic hormone therapy (progestin, levonorgestrel IUD, or birth control pills).
- Do not use synthetic hormone therapy. Another treatment option bioidentical progesterone identical to what your body produces may be more appropriate for you.
- The decision whether to treat heavy menstrual (dysfunctional uterine) bleeding with synthetic hormone therapy takes into account your personal feelings and the medical facts.