Anemic in Annapolis

Dear Dr. Jane,

murray_webI am 48 years old and experiencing very heavy periods in the last 6 months. My periods are fairly regular, but the first 2 or 3 days I am miserable! I wear super tampons and extra heavy pads and still worry about soaking through. My doctor says I am anemic and I have a fibroid in my uterus. He is recommending a hysterectomy to treat me. What should I do?

Anemic in Annapolis


Dear Anemic,

Heavy bleeding in perimenopause is a common problem. As a woman gets closer to menopause, her progesterone levels decline substantially, while estrogen can actually be higher on average than when she was younger. This sets up a situation where fibroids can grow, and also the lining of the uterus does not shed in as regular a way as previously. Fibroids are non-cancerous tumors of the uterine muscle that can occur anywhere in or on the uterus; they can cause heavy bleeding and sometimes are quite painful.

Depending upon where the fibroid is located in the uterus, a hysterectomy may be needed. However, in some cases, other options are available. One is called “laser ablation” and may be appropriate for some fibroids. Another technique, actually performed by a radiologist, is called a “fibroid embolization,” where the arteries to the fibroid are identified using a special injected dye, and then the specific arteries feeding the fibroid are filled with tiny particles that block off the artery and effectively kill the fibroid. Sometimes surgery can be done to remove the offending fibroids only and not the entire uterus.

Other women with heavy bleeding have hormone imbalance, as mentioned above, and adding progesterone to their systems to balance estrogen’s stimulation of the lining can be effective. Some situations of heavy bleeding can be controlled with procedures that spare the uterus from removal (hysterectomy) but change the lining in ways that keep it from bleeding. Such procedures are called “uterine ablation” and can involve freezing, laser or burning the lining with various instruments that cauterize the lining and keep it from bleeding.

Your specific condition should be reviewed carefully with your doctor to determine the best approach in your individual situation.