Managing Irregular Periods: When to Consider Uterine Removal?

Menstruation has started and won't stop?

Hello, doctor.
Since April of last year, I have not had my period for three consecutive months.
After taking medication to induce menstruation, my periods were normal for the first two months, but in the third month, the flow increased significantly (about two to three times more than usual) with a lot of blood clots, and I couldn't stop it.
I had to rely on medication to stop it.
After taking Western medicine for three months, I switched to traditional Chinese medicine.
Initially, it helped to stop my menstruation, but in June of this year, it suddenly became ineffective.
After increasing the dosage, it still did not work, and I have developed severe anemia over the past year, with my weight dropping from 42 kg to 37 kg.
I had to seek help from Western medicine again.
After undergoing a hysteroscopy, the doctor found no abnormalities in the uterus, only ovulatory dysfunction.
The doctor suggested adjusting my medication for three months to see if my cycle normalizes.
If it does not, what should I do? I previously asked the doctor if I could have a hysterectomy to resolve this persistent issue, and the doctor said it was not yet necessary, but I can no longer tolerate this situation.
If after three months of treatment I still cannot return to normal, can I have a hysterectomy to solve this troubling problem? Thank you.

finny, 40~49 year old female. Ask Date: 2006/10/12

Dr. Xu Junzheng reply Obstetrics and Gynecology

Your issue may require a physician's personal examination to understand, as it is not possible to determine the cause based solely on symptoms.
Thank you!

Reply Date: 2006/10/12

More Info

Managing irregular periods can be a complex issue, especially when it involves hormonal treatments and potential surgical interventions like a hysterectomy (removal of the uterus). Based on your description, it seems that you have been experiencing significant menstrual irregularities and complications, including heavy bleeding and anemia, which have not responded well to various treatments.

Firstly, it's important to understand that irregular periods can stem from a variety of causes, including hormonal imbalances, stress, significant weight changes, and underlying health conditions. In your case, it appears that you have been dealing with ovulatory dysfunction, which can lead to unpredictable menstrual cycles and heavy bleeding. This can be particularly distressing and can significantly impact your quality of life.

The initial approach to managing irregular periods typically involves hormonal treatments, such as birth control pills or other medications that can help regulate the menstrual cycle. However, as you've experienced, these treatments may not always be effective, and in some cases, they can lead to side effects like heavy bleeding or breakthrough bleeding.

Given that you have already tried both Western and traditional Chinese medicine without achieving satisfactory results, and considering the severity of your symptoms (such as significant weight loss and anemia), it is understandable that you are seeking a more definitive solution. A hysterectomy is a significant surgical procedure and is generally considered a last resort after other treatment options have been exhausted.
Your physician's recommendation to continue with hormonal treatment for an additional three months is a common approach. This allows time to assess whether the body can stabilize and return to a more regular menstrual pattern. If, after this period, your symptoms persist and you continue to experience heavy bleeding and anemia, it would be reasonable to revisit the discussion about a hysterectomy.

It's crucial to have a thorough discussion with your healthcare provider about the potential risks and benefits of a hysterectomy. While it can provide relief from the symptoms of heavy bleeding and irregular periods, it also involves the loss of fertility and can have other long-term implications for your health. Additionally, it is essential to explore all possible underlying causes of your symptoms, including any potential issues with your ovaries or other reproductive organs, as these may also need to be addressed.

In summary, while a hysterectomy can be an effective solution for managing severe menstrual irregularities, it should be considered carefully and discussed thoroughly with your healthcare provider. If you find that your symptoms do not improve after the proposed treatment period, it would be appropriate to have an open conversation with your doctor about the possibility of surgical intervention and to explore all your options for managing your health moving forward. Always ensure that you are fully informed about the implications of any treatment decision you make.

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