Dysfunctional Uterine Bleeding: Should I Use Hormone Therapy?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Dysfunctional Uterine Bleeding: Should I Use Hormone Therapy?
Get the facts
Key points to remember
- If your doctor says that you have dysfunctional uterine bleeding, you may choose to wait and see if your bleeding gets better (watchful waiting) without treatment. If you are a teen, your cycles are likely to even out as you get older. Women who are close to menopause will have a natural end to menstrual bleeding over time.
- Treatment can help make menstrual bleeding regular. You may have to try more than one type of treatment to find one that works for you.
- Hormones, such as a progestin pill or a daily birth control pill, may help make your menstrual cycle regular and reduce bleeding and cramping.
- Smoking while taking the estrogen-progestin birth control pill increases the risk of blood clots and high blood pressure. Progestin and the levonorgestrel IUD don't have these two risks. Estrogen-progestin birth control pills usually aren't prescribed if you smoke and are older than 35.
- If you don't plan to ever get pregnant, you may choose to have endometrial ablation or a hysterectomy.
Dysfunctional uterine bleeding is menstrual bleeding that is not normal for you and that isn't caused by a serious problem such as disease or a problem during pregnancy. It is usually caused by abnormal changes in hormone levels, which may affect ovulation. This bleeding problem is most common during the teen and perimenopausal years.
You may have abnormal bleeding if you have one or more of these symptoms:
- Menstrual bleeding occurs more often than every 21 days. A normal menstrual cycle is 21 to 35 days long.
- Spotting occurs between menstrual periods.
- Menstrual bleeding lasts longer than 7 days. Most periods last 4 to 6 days.
- You have blood loss of more than 80 mL (2.7 fl oz) each menstrual cycle. About 30 mL (1 fl oz) is normal for most women. If you are passing blood clots or soaking through your usual pads or tampons each hour for 2 or more hours, your bleeding is heavy.
These symptoms also can be signs of a serious problem. If you have the above symptoms, your doctor will check to make sure that you don't have a problem like a miscarriage or a disease.
Heavy uterine bleeding can lead to anemia, which can make you weak, pale, and very tired. If bleeding is very bad, a blood transfusion can quickly restore needed blood.
Over time, abnormal uterine bleeding can make it hard for you to have an active life. It can get in the way of sports and sexual activity.
You can choose from several treatments. Each of these treatments works well for some women, but not others. Treatments include:
- Watchful waiting. Sometimes the bleeding gets better on its own. Menstrual cycles usually even out as a teen's body matures, and a woman's cycles end at menopause.
- Hormone treatment.
- Birth control (progestin and estrogen) pills can help make your cycle regular, prevent ovulation, and reduce or stop menstrual bleeding.
- Progestin treatment can help you start bleeding normally.
- The levonorgestrel IUD releases a form of the hormone progesterone into the uterus. This reduces bleeding and prevents pregnancy.
- Surgery, such as dilation and curettage (D&C) for short-term relief of severe bleeding or endometrial ablation for longer-term relief. Or the uterus can be removed (hysterectomy) to end heavy bleeding that can't be stopped in other ways.
- In rare cases, medicines that stop your body from making estrogen and having menstrual periods, such as gonadotropin-releasing hormone analogues (GnRH-As). This drug isn't used much for long-term treatment, because it can cause severe side effects.
- You have heavy menstrual periods that cause you a lot of pain.
- Heavy bleeding makes it hard to do your usual activities.
- You want to control bleeding and still be able to have children.
- You don't want to have a procedure or surgery to fix the bleeding.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- You can take birth control (progestin and estrogen) pills. Depending on the type of pill, you take the pills for a certain number of days each month and then stop for a few days to have your period.
- Or you can take progestin pills daily or 10 to 12 days every month.
- If you choose the levonorgestrel IUD, your doctor places the IUD in your uterus.
- All of these hormones can make your breasts tender and cause headaches, nausea, and bloating.
- Certain birth control pills increase the risk of blood clots. This risk is higher if you are over 35 and smoke.
- Birth control pills also may increase the risk of breast cancer by a very small amount.
- If you want to get pregnant, you will have to wait until you have stopped taking hormones.
- You can wait and see if the bleeding gets better on its own. You may be able to take nonsteroidal anti-inflammatory drugs (NSAIDs) for pain.
- You may decide to try hormones later.
- You may choose to have a procedure such as D&C, endometrial ablation, or surgery to take out your uterus (hysterectomy).
- If you have your uterus removed or have ablation, you will no longer be able to get pregnant.
- Bleeding could get better on its own.
- You don't have a risk of side effects from hormones.
- You may be able to get pregnant when you want.
- Your bleeding and pain might not get better or could get worse. This could affect sex and other activities.
- If you have surgery, you will have the usual risks of surgery, such as bleeding or infection.
- Endometrial ablation can cause a puncture of the uterus and other problems, but these aren't common.
- Not all people can take NSAIDs, which can cause side effects such as stomach bleeding.
Personal stories about treating dysfunctional uterine bleeding with hormone therapy
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I was surprised when my doctor called my heavy periods "dysfunctional uterine bleeding." I had never heard of dysfunctional uterine bleeding before. He told me that it isn't serious but that I could try a treatment that would lighten the bleeding. First, I tried taking ibuprofen during my periods, but I didn't notice a big difference. When he said that a special IUD with hormones might control the bleeding, I thought I might as well try it, because it also keeps me from getting pregnant. The IUD worked. I don't have heavy periods any more, and I feel great.
Jean, age 29
My periods were so unpredictable. They drove me crazy! One month, my period might start 3 weeks after the last one and be light, and next time it wouldn't start until 6 weeks later. Then, it would be very heavy and last a long time. When I had heavy bleeding, it was so bad I could not exercise. I am an active person, so this was really getting me down. My doctor checked me over, reassured me that I don't have cancer or anything, and said maybe it was time for surgery. I asked if there were any other options, since the last time I had surgery it took me months to recover. I didn't want to go through that again. My doctor said a medicine called progestin might help me, because tests showed that I don't have enough progesterone. After starting the medicine, I did have some water retention and weight gain, but my periods are normal. I think taking this medicine works well for me.
Megan, age 38
I had such bad, heavy periods that one day my mom had to take me to the emergency room, I was losing so much blood. They gave me some blood and gave me something that stopped the bleeding after a couple of hours. Then I took some hormone pills for a few days, had a heavy period, and then started taking a birth control pill every day. That has really helped!
Melissa, age 15
I'd heard that I could take the Pill for my crazy periods, mood swings, and hot flashes. My nurse practitioner wanted to be sure I didn't have anything like uterine cancer, so I had tests and a biopsy first, because at my age cancer risk is a concern. Anyway, I checked out fine and started the Pill. It didn't really help. In fact, I got kind of depressed. Then I tried another kind of Pill, and the hormones seemed to be better for me. My mood is better, and the bleeding is at least more regular, and it's gotten less and less over the past few months.
Carlotta, age 45
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take hormones for uterine bleeding
Reasons not to take hormones for uterine bleeding
My bleeding and pain make it hard to enjoy my daily activities.
I'm still able to do the things I enjoy.
I don't plan on getting pregnant soon.
I don't want to have to wait to get pregnant.
I'm not worried about the side effects of hormones.
I don't want to have any side effects from hormones.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
NOT taking hormones
What else do you need to make your decision?
Check the facts
Any of the hormone treatments will stop my bleeding.
- TrueSorry, that's not right. You may have to try more than one type of treatment to find one that works for you.
- FalseThat's right. You may have to try more than one type of treatment to find one that works for you.
- I'm not sureIt may help to go back and read "Key points to remember." You may have to try more than one type of treatment to find one that works for you.
Hormones are the only way to treat my uterine bleeding.
- TrueSorry, that's not right. You can wait and see if the bleeding gets better without treatment. Or you can have a procedure or surgery.
- FalseYou're right. You can wait and see if the bleeding gets better without treatment. Or you can have a procedure or surgery.
- I'm not sureIt may help to go back and read "Key points to remember." You can wait and see if the bleeding gets better without treatment. Or you can have a procedure or surgery.
Taking birth control pills for my bleeding might not be a good idea if I'm over 35 and I smoke.
- TrueYou're right. Smoking while taking estrogen-progestin birth control pills increases the risk of blood clots and high blood pressure. This risk is higher if you're over 35.
- FalseThat's not right. Smoking while taking estrogen-progestin birth control pills increases the risk of blood clots and high blood pressure. This risk is higher if you're over 35.
- I'm not sureIt may help to go back and read "Key points to remember." Smoking while taking estrogen-progestin birth control pills increases the risk of blood clots and high blood pressure. This risk is higher if you're over 35.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|
|Specialist Medical Reviewer||Kirtly Jones, MD - Obstetrics and Gynecology|