By Karina Hoan, MD, minimally invasive gynecologist at The Portland Clinic.
By the time women come to me seeking help for debilitating pelvic pain or heavy, painful periods, they’ve often been suffering in silence for years. In many cases, they simply didn’t know they had treatment options. So let’s break the silence and talk about what’s normal, what’s not, and the options that can help.
A normal menstrual period generally involves moderate bleeding for three to five days, with mild cramping and discomfort that can be relieved with a dose or two of ibuprofen or naproxen. Constant pelvic pain, on the other hand, and heavy periods that put you out of commission for days are not normal. These may be caused by underlying problems, and those problems may be treatable.
Uterine fibroids are one of the most common causes of heavy, painful periods. Up to 60 percent of all women develop these benign growths. Endometriosis, another cause of pelvic pain, affects about 10 percent of women. In this condition, cells from the lining of the uterus (the endometrium) start growing in the pelvis, causing inflammation and pain. In a similar but less-common condition, called adenomyosis, endometrial tissue grows in the muscular wall of the uterus. All of these conditions can be treated.
Treatment options for fibroids
Many women have fibroids that cause no symptoms and aren’t a problem. But in some women, fibroids cause very heavy cycles, pain or heaviness in the pelvis, and frequent urges to urinate. Fibroids also can impede efforts to get pregnant.
I always encourage women to try the least invasive treatment that will allow them to achieve their goals. If abnormal bleeding is the main problem, birth control pills, IUDs or contraceptive injections (such as Depo Provera) can help decrease or stop menstrual bleeding, which resolves much of the discomfort.
If symptoms continue despite these treatments, there are two surgical options: myomectomy, which is removing just the fibroids, or hysterectomy, which is removing the entire uterus.
For women who want to maintain the option for a future pregnancy, myomectomy removes the fibroids that pose obstacles to pregnancy, and it leaves the uterus intact. The downside is that fibroids can start to regrow immediately, so it may not be a permanent solution.
When childbearing is no longer a goal, hysterectomy is the definitive treatment for two reasons: it eliminates all fibroids and prevents any future fibroids, and it is a less complicated procedure with lower bleeding risks than myomectomy.
Today, most myomectomies and hysterectomies are performed as minimally invasive laparoscopic or robotic-assisted surgeries. These techniques involve much smaller incisions than open surgeries, which means less pain (and less need for medication), fewer complications and shorter recovery time for patients. A minimally invasive hysterectomy, for example, takes only about an hour and a half to complete; most patients go home within two to six hours and are back to work in about two weeks.
Treatment options for endometriosis and adenomyosis
Endometriosis and adenomyosis both respond well to hormone-suppressing medications, such as birth control pills, which slow or halt new tissue growth. Over-the-counter anti-inflammatories also help with pain. If these treatments fail, surgical options can help. For endometriosis, minimally invasive surgery to remove the abnormal tissue, followed by continuing hormone therapy to prevent new growths, provides great relief for most women. For severe adenomyosis, a hysterectomy is the only definitive treatment.
Through either a tailored medication regimen or minimally invasive surgery, the vast majority of women can put an end to chronic pelvic pain. So don’t feel that you have to tough it out: if your periods or pelvic pain are incapacitating, talk to a gynecologist about possible causes and treatments. You may be back to enjoying life again before you know it.
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