Update re: heavy periods, perimenopause

[wendibird22]

I posted last month about dealing with years of heavy periods, perimenopause symptoms etc. https://windsorpeak.com/vbulletin/showthread.php?510191&p=4387292#post4387292

I had my sonohystergram last week and my doctor followed up with me today (via nurse message). My uterine lining is fine and of normal thickness. I do have one fibroid that could be pushing on the uterus, which the doctor said could cause heavier bleeding (pushing on uterus causes more uterine surface area, cause more surface to shed). She also said it could just simply be perimenopause. They did biopsy the endometrium (that's required in order to be considered for more invasive solutions such as ablation) and that came back fine.

So, the voicemail message I had from the nurse said the doctor is suggesting either going back on BPC or try Liletta IUD. I tried a BCP about a year and a half ago and immediately gained 10lbs and just didn't feel myself on it so I discontinued it after a few months. I had the Mirena IUD about 10yrs ago, after the birth of DD2, but had it removed after about 9 months because I was constantly spotting and I had a host of other symptoms like headaches, bloating, etc. Now, that was before I was diagnosed as gluten intolerant and I had the Mirena removed before going GF, so while the spotting likely wouldn't have gone away the other symptoms likely we not caused by the IUD (though I do wonder if the sensitivity was sparked by the IUD as I didn't have symptoms before having it placed).

So, now I have to decide...BCP or Liletta. What would you do?

[gymnbomb]

Personally I would probably try the pill first, in part because if you don't like it you just stop taking it vs. having to have something removed. And I'd talk to the doctor about previous experience on it and see if they could recommend a different pill.

[JBaxter]

Did you discuss ablation ?

[SnuggleBuggles]

I'd definitely pick the IUD. I really don't like the pill and the typical side effects. Plus, I am terrible about remembering to take meds. I know that there are many versions of the pill now so I guess I shouldn't give a blanket no...but for me it is always going to be a no. ;)
I have had 3 IUDs now and the process was no biggie. I watched the most traumatic step by step account of someone getting an IUD on Buzzfeed and it was absolutely nothing like my experience! I had no numbing meds. Totally unnecessary. No ultrasound. Nothing really more involved than a pap. But if I didn't know any differently and just saw that Buzzfeed, I would be a "never!" on the IUD front too. Sorry, just rambling. I really like the convenience of IUDs but I can see the hesitation if there's no guarantee that it'll help.

[gatorsmom]

I vote BCP. I love the mini pill. I always take it right before bed with my vitamins and since it’s only for controlling bleeding, it doesn’t matter when exactly that I take it, as long as I don’t skip a day. I take them everyday and don’t stop for a period, per my doc’s directions. I particularly love them though for regulating my moods. I don’t have any ups and down days anymore. It’s wonderful. I take Norlyda which is norethindrone.

Like pp said, if you don’t like them, you can stop easily and try something else.

[wendibird22]

Did you discuss ablation ?

She said it was an option but wasn't keen to recommend it as a first step.

[wendibird22]

I'd definitely pick the IUD. I really don't like the pill and the typical side effects. Plus, I am terrible about remembering to take meds. I know that there are many versions of the pill now so I guess I shouldn't give a blanket no...but for me it is always going to be a no. ;)
I have had 3 IUDs now and the process was no biggie. I watched the most traumatic step by step account of someone getting an IUD on Buzzfeed and it was absolutely nothing like my experience! I had no numbing meds. Totally unnecessary. No ultrasound. Nothing really more involved than a pap. But if I didn't know any differently and just saw that Buzzfeed, I would be a "never!" on the IUD front too. Sorry, just rambling. I really like the convenience of IUDs but I can see the hesitation if there's no guarantee that it'll help.

Yes, my Mirena was an easy process, just like yours.

[pinkmomagain]

I've had a wonderful experience with Mirena, truly. So my vote is IUD.

[JBaxter]

She said it was an option but wasn't keen to recommend it as a first step.

But you have had negative reactions to both methods they recommended :(

[AngB]

But you have had negative reactions to both methods they recommended :(

This. Neither. I'd get an ablation. At most, I'd tell her I was going on BCP and let her order the rx and then tell her it wasn't working. But really I would tell her neither of those have been good options for you in the past and I want an ablation.

[Kestrel]

Has your doctor had you try Tranexamic Acid? It's a prescription drug that you take for a few days each month, starting the pills when you start your bleeding days of your cycle and continuing four or five days. Then off until you start your next cycle. It's cheap and easy, and might be worth a try. I've been taking it for three cycles in preparation for my upcoming hysterectomy to try and get my iron levels up before surgery. It lightens or stops your volume of bleeding.

[essnce629]

Did you ever get the Period Repair Manual book I recommended in your previous post?
https://www.amazon.com/dp/1975926773/ref=cm_sw_r_cp_apa_fabc_73FFB1ZDN8Q6F0GN2W3A?_enco ding=UTF8&psc=1

I incorporated her suggestions 3 months ago and my periods are now much lighter (heavy for half a day only) and no more clots (I was passing clots larger than a quarter all the time which is apparently not normal according to the book). My iron levels are also in the normal range now and I was able to skip my last IV iron infusion (was getting them every 6-8 weeks).

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[wendibird22]

Did you ever get the Period Repair Manual book I recommended in your previous post?
https://www.amazon.com/dp/1975926773/ref=cm_sw_r_cp_apa_fabc_73FFB1ZDN8Q6F0GN2W3A?_enco ding=UTF8&psc=1

I incorporated her suggestions 3 months ago and my periods are now much lighter (heavy for half a day only) and no more clots (I was passing clots larger than a quarter all the time which is apparently not normal according to the book). My iron levels are also in the normal range now and I was able to skip my last IV iron infusion (was getting them every 6-8 weeks).

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I did read it and found it very informative. I am still looking into micronized or natural progesterone and I started turmeric. Most of the other things suggested for heavy bleeding I am already doing. I have a low inflammation diet (GF and very low to no dairy), take a daily probiotic for gut health, exercise, take ibuprofen, etc. My iron and thyroid levels are always in the normal range, so that is good.

[KpbS]

If it were me, I would try a different bcp than you have taken in the past and see if you can find one that works better with your body. I take bcp continuously to for endo and heavy/painful flow. I'm not a candidate for an ablation based on some uterine differences (shape, tipped, etc.) so this is how I've bought time.

[wendibird22]

I think I'm going with trying another BCP. I called the nurse back and said I'd be willing to give it a try, would require it to be something different from the last one, reminded her/them that I only need it for heavy bleeding not BC. I figured it is easy enough to start/stop after giving it a few months, vs placement and removal of an IUD. I will keep ablation in my back pocket, though a discussion in a FB group I'm in for moms in my profession recently had a discussion about ablation and the number of women who reported a failed ablation was astounding to me.

[essnce629]

I did read it and found it very informative. I am still looking into micronized or natural progesterone and I started turmeric. Most of the other things suggested for heavy bleeding I am already doing. I have a low inflammation diet (GF and very low to no dairy), take a daily probiotic for gut health, exercise, take ibuprofen, etc. My iron and thyroid levels are always in the normal range, so that is good.Are you taking the calcium d-glucarate? That is the supplement that was a game changer for me. It binds to excess estrogen and helps your body to get rid of it. If heavy periods are caused by excess estrogen then this solves that problem. I take 1000mg a day of the Thorne brand (started with 500mg the first month).

I was already eating gluten-free, little dairy, and taking probiotics (although I've since switched to one that helps bind to estrogen), so it was definitely something besides that which helped.

I was considering ablation when I turned 40 (this year) but have taken it off the table after my success with the supplements and after reading women's negative experiences with it (in a FB group for women with heavy periods).

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[gatorsmom]

I will keep ablation in my back pocket, though a discussion in a FB group I'm in for moms in my profession recently had a discussion about ablation and the number of women who reported a failed ablation was astounding to me.

I had heard this too and it was one reason I wanted to exhaust all other options before trying ablation.

[wendibird22]

So I’ve now been on BCP since March and have no change in my heavy periods, or at least not significant improvement. First month I spotted for three weeks. That stopped thankfully and my period is now regular in that it starts day 2 of the placebo pill and lasts 5 days. I still have a heavy day and that seems to be day 3 of my period. I’m emptying a diva cup every 2hrs or so. Now, I had been filling it every hr pre BPC but still every 2hrs is a very heavy flow. I also gained 5lb with the pill.
(Which explains why IF seems to have stopped working!)

So what next? My annual visit isn’t until end of September and it’s with a PA not the doc I saw for heavy bleeding. And they probably won’t let me discuss this problem at my annual as you are supposed to have a “problem visit” scheduled for anything not routine. I’m guessing I can call and ask for phone consult with doc about next steps.

PS: haven’t tried calcium d-glucarate. Looking into that now.

ETA: calcium d-glucarate arrived today! Fingers crossed it helps.

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[amyx4]

I was seen every three months for a year to find the right pill. Every three months, we'd change the Rx until I was happy.

[Kestrel]

If you've been on the new pills for three full cycles, and there's no improvement, it's time to try something else. I would call and see if they can just do a new script over the phone for a new kind. If it's not working by now, chances are it's not going to.

I had my hysterectomy in March. Best decision ever. It took me a long time to get there; and I'm recovering slower than normal... but it was so the right decision for me. My iron and vitD went from undetectable to normal, I went from sleeping 12+ hours a day and being a zombie to 9 hours and fairly normal, and gave four huge bags of tampons/pads/depends to the homeless shelter. I'm still only maybe 85-90%, but getting stronger. Better than I've been in at least five years, and still improving.

Don't hesitate to stand up and say it's not working for you. If your doc won't listen, scream louder! If they still won't listen, find another doc.

[Kestrel]

Oh... and do tell the doc about Tranexamic Acid I mentioned above. It's a new treatment.

[mom2binsd]

Is there a reason you are taking the placebo, can you just do a continuous 3 week dose?

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[wendibird22]

Is there a reason you are taking the placebo, can you just do a continuous 3 week dose?

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I always get breakthrough bleeding/spotting when I try that. I also spotted constantly with an IUD. I think my body is bound and determined to bleed no matter what!

Kestrel, I'll definitely ask about Tranexamic Acid.

[calebsmama03]

Are you taking the calcium d-glucarate? That is the supplement that was a game changer for me. It binds to excess estrogen and helps your body to get rid of it. If heavy periods are caused by excess estrogen then this solves that problem. I take 1000mg a day of the Thorne brand (started with 500mg the first month).

I was already eating gluten-free, little dairy, and taking probiotics (although I've since switched to one that helps bind to estrogen), so it was definitely something besides that which helped.

I was considering ablation when I turned 40 (this year) but have taken it off the table after my success with the supplements and after reading women's negative experiences with it (in a FB group for women with heavy periods).



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Thanks for this info! I'd never heard of this supplement before and am going to try it after doing some research. I had an awful time with mirena years ago (spotted or bled continually for 4+ months, headaches, severe nausea, sore swollen breasts - I seriously thought I was pregnant the entire time.) I couldn't tolerate it so had it removed 5 mos in. BCPs and depo provera don't agree with me - I seem to be very hormone sensitive. Previous GYN wanted me on BCPs, which I refused. Current GYN is pushing hysterectomy due to my endometriosis and "you don't need it anyway since you're done having kids" but I don't like the idea, at least not yet. Just so sick of cycles lasting less than 3 weeks and bleeding so heavily that I'm sprinting to the bathroom every hour even with a large Diva!

What probiotic are you taking? Any side effects from the calcium d-glucarate?

[wendibird22]

So I’ve now been on BCP since March and have no change in my heavy periods, or at least not significant improvement. First month I spotted for three weeks. That stopped thankfully and my period is now regular in that it starts day 2 of the placebo pill and lasts 5 days. I still have a heavy day and that seems to be day 3 of my period. I’m emptying a diva cup every 2hrs or so. Now, I had been filling it every hr pre BPC but still every 2hrs is a very heavy flow. I also gained 5lb with the pill.
(Which explains why IF seems to have stopped working!)

So what next? My annual visit isn’t until end of September and it’s with a PA not the doc I saw for heavy bleeding. And they probably won’t let me discuss this problem at my annual as you are supposed to have a “problem visit” scheduled for anything not routine. I’m guessing I can call and ask for phone consult with doc about next steps.

PS: haven’t tried calcium d-glucarate. Looking into that now.

ETA: calcium d-glucarate arrived today! Fingers crossed it helps.

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I've been taking 500mg of the calcium d-glucarate, but haven't noticed a difference. I will try increasing to 1000mg.


I was seen every three months for a year to find the right pill. Every three months, we'd change the Rx until I was happy.

Had my Sept appointment and have an RX for a new BCP, Mili, which I guess is the replacement for Sprintec (which I remember being on many years ago). I stopped the other low dose BCP in Aug and had a "normal" period this month (normal, is in not on BCP) and it was as heavy as ever, even with the calcium d-glucarate. I'll start the pack of Mili BCP in a few weeks. The PA said to give it 3 months and see if there's any change and if not we can discuss next options.

I wish I could know how close I am to menopause or if my hormones are way out of wack. GYN office won't do any hormonal bloodwork because they say they just fluctuate too much day to day to be of any use to measure.

[essnce629]

I've been taking 500mg of the calcium d-glucarate, but haven't noticed a difference. I will try increasing to 1000mg.

I take 2000mg (4 capsules) a day. 2 at lunch and 2 at dinner. Thorne brand.


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[Ceepa]

Oh... and do tell the doc about Tranexamic Acid I mentioned above. It's a new treatment.

My dr brought up Tranexamic Acid to me. I hadn't heard of it before so can't comment on experience like Kestrel. I'm not going that route but it sounded promising if you are a candidate.

[dogmom]

But you have had negative reactions to both methods they recommended :(

Well, the only clear negative effect of the IUD was the spotting, which might not be the case now. The other symptoms may well have been to gluten. Also, after 10 years the reaction to the IUD may well be different. Because of the different clotting profile of IUD vs oral contraceptives, since IUDs are less systemic, I think they are better choices for older women.

Ablations are helpful for some people, but they are more invasive, need to be done in the hospital and need anesthesia. They also often have medical insurance hoops to jump through and can be expensive for uncovered costs for some. For some people they work. Others I see back in a couple years getting a hysterectomy. Personal I would try and IUD first, then see. They do have a place, I am just unsure if the OP is there yet.

Here is a review paper on ablations: https://www.jogc.com/article/S1701-2163(15)30288-7/pdf

Edited: I don’t get the turmeric, by the way. What is the thought process on that? I know some doses can impede clotting and since it’s not regulated we tell everyone to stop taking it weeks before surgery.

[wendibird22]

Well, the only clear negative effect of the IUD was the spotting, which might not be the case now. The other symptoms may well have been to gluten. Also, after 10 years the reaction to the IUD may well be different. Because of the different clotting profile of IUD vs oral contraceptives, since IUDs are less systemic, I think they are better choices for older women.

Ablations are helpful for some people, but they are more invasive, need to be done in the hospital and need anesthesia. They also often have medical insurance hoops to jump through and can be expensive for uncovered costs for some. For some people they work. Others I see back in a couple years getting a hysterectomy. Personal I would try and IUD first, then see. They do have a place, I am just unsure if the OP is there yet.

Here is a review paper on ablations: https://www.jogc.com/article/S1701-2163(15)30288-7/pdf

Edited: I don’t get the turmeric, by the way. What is the thought process on that? I know some doses can impede clotting and since it’s not regulated we tell everyone to stop taking it weeks before surgery.

This is helpful! Yes my OB mentioned that for insurance you have to show you’ve tried all the other things before you can get coverage for ablation.

Your response and the other thread on Mirena have me seriously considering that route. I did request the new BCP but haven’t started the first pack yet. Thinking of calling my OB office and seeing about scheduling IUD…my office uses Liletta now but said it’s the same as Mirena.


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[dogmom]

This is helpful! Yes my OB mentioned that for insurance you have to show you’ve tried all the other things before you can get coverage for ablation.

Your response and the other thread on Mirena have me seriously considering that route. I did request the new BCP but haven’t started the first pack yet. Thinking of calling my OB office and seeing about scheduling IUD…my office uses Liletta now but said it’s the same as Mirena.


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full disclosure, I had the Mirena. I got it on suggestions of the Gyn fellow when I was going worked up for an incidental finding of a mixed ovarian cyst. I started having some BP issues afterwards (mid 40’s), but in reality it was I was getting my BP taken more often for more doctors visits and I started following it more, so I probably already had borderline hypertension. I sort of went crazy going down Internet rabbit holes on effects or hormonal IUDs. Complained to him about the BP, he said it was unlikely and probably more likely I was in my mid 40’s and starting to develop essential hypertension. He said it nicely. I manage to put my nurse brain on and realize he was probably correct. Got my tubes tied during ovarian cyst surgery, got on low dose lisinopril, kept the IUD for period control. Got IUD out 5 years later when they were in there for another procedure, cursed myself for getting it out for 2 years before menopause finally hit. Continued with my hypertension, well controlled if I’m on medication, well past getting it out. So it was not the IUD causing my high blood pressure at all. I’m not saying some women don’t have issues with it, but I think it’s worse trying. If you’ve had vaginal births they tend not to be that bad to put in and take out for most women. I found one big dose of ibuprofen was all I needed.

BTW: Women actually have harder to control hypertension than males, they just get it a little later and no one hears about it.

[StantonHyde]

I was on Mirena for 15 years after the birth of my second/last child at age 40. I also take an SSRI. I have had very, very few perimenopause symptoms. Mild hot flashes a few times a day. I had some increased anxiety at one point and definitely more periods of forgetfulness. I am a lucky Mirena user--almost zero break through bleeding in 15 years. I loved that thing. I am fine now that it is out since I am post menopausal. But it was great.

[wendibird22]

Another update. Decided to skip even trying pill #2 and just going to the IUD. Since stopping the other BCP two months ago (that I started back in January) I’ve already shed the few pounds I put on when I started it and feel like I’m sleeping better. I just am not keen on the systemic hormone influence…I wasn’t before either but hoped the payoff would be controlled bleeding (fail!). So I called my gyn office and much to my surprise they can get me jn next week to place the Liletta iud (equivalent to Mirena). I was expecting to have to wait a few months to get an appointment. I got off the phone sooo excited and so that affirms my decision to give it a try. At this point I’ll take the constant spotting I had with Mirena over the heavy bleeding.


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[wendibird22]

So after failed insertion attempt last week (see my post in the BP), I returned yesterday for attempt #2. Took a med the night before to dilate my cervix. Well that didn’t work and attempt 2 also failed. But the doc was awesome and really wanted this to work for me. So she had them prep the procedure room, got the ultrasound tech, and did it by guided ultrasound. Turns out my uterus is tipped very far forward and there’s a bit of scar tissue near the upper os of my cervix and so the instruments couldn’t get through to the uterus. So she basically clamped my cervix and pulled it down in order to get a straight line into the uterus. Good thing I have a very high pain tolerance. Even with the straighter line the equipment kept hitting a ridge of tissue in my cervix and it took MULTIPLE attempts plus several metal dilators to get it in. But success! It’s in there. And at least I know it’s placed perfectly and didn’t go through my uterus which honestly could’ve happened in attempt 1 and 2 without them knowing just how tipped my uterus is.

So now we play the waiting game and hope and pray that over time this lessens my monthly flow. Cause gosh by golly that took a Herculean effort for it to not work!


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[dogmom]

So after failed insertion attempt last week (see my post in the BP), I returned yesterday for attempt #2. Took a med the night before to dilate my cervix. Well that didn’t work and attempt 2 also failed. But the doc was awesome and really wanted this to work for me. So she had them prep the procedure room, got the ultrasound tech, and did it by guided ultrasound. Turns out my uterus is tipped very far forward and there’s a bit of scar tissue near the upper os of my cervix and so the instruments couldn’t get through to the uterus. So she basically clamped my cervix and pulled it down in order to get a straight line into the uterus. Good thing I have a very high pain tolerance. Even with the straighter line the equipment kept hitting a ridge of tissue in my cervix and it took MULTIPLE attempts plus several metal dilators to get it in. But success! It’s in there. And at least I know it’s placed perfectly and didn’t go through my uterus which honestly could’ve happened in attempt 1 and 2 without them knowing just how tipped my uterus is.

So now we play the waiting game and hope and pray that over time this lessens my monthly flow. Cause gosh by golly that took a Herculean effort for it to not work!


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Oh my goodness! The things we go through….
I probably would have been very annoyed, but also gone through with it. It would have been worth it for me. I will say it seems like 9/10 women I know have had really good responses to hormonal IUD for the reasons you are getting it. 1/10 just haven’t worked out well. May the odds be in your favor.

[SnuggleBuggles]

Phew! I’m sure you’re glad that’s over. I hope it helps! I adore my copper iud and hate that I wasted any of my life on BCPs.


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[bisous]

I'm so glad the doctor kept trying! Now everything is in place. Here's hoping it brings all the relief you need.

[Kestrel]

I'm so glad you got there!

I think only those who have been there know just how much these issues effect everyday life. (ie - I just cleaned out my car for winter, and took out all the black towels I kept there to cover my seats to protect them from leaks/bleeding through clothes. So happy with my hysterectomy!)

I hope you finally get the relief you need!

[marinkitty]

Goodness, what an ordeal! I hope it is smooth sailing from here. I agree with the PP who says it's hard to know how awful these issues are until you have lived through them. I'm about five years post-hysterecotomy and very happy with it, but for your sake I hope that your Mirena is the final solution.