Treatment plans for heavy periods should be based on the cause. Women with factor deficiencies may need blood or factor transfusions. Hormone imbalances and benign hyperplasias can be treated with combinations of estrogen, progesterone and the birth control pill, as well as the progesterone releasing IUD called Mirena. Thyroid and prolactin problems are treated with specialized medications for these conditions.
Depending on your age and childbearing desires, there are many modalities used to treat structural problems.
Fibroids in the lining of the uterus (submucus) can be removed with a resectoscope loop in an operative hysteroscopy (a small telescope is placed through a dilated cervix into the uterus and fluid under pressure is used to open the walls of the uterus and fibroids or polyps can be removed under direct visualization).
Fibriods in the wall or on the outside of the uterus can be removed through a laparoscopy or open incision where removal of the fibroid (myomectomy) or removal of the whole uterus (hysterectomy) is accomplished.
Uterine cancers and precancers are treated with hysterectomy.
Endometrial ablation using radiofreqency, cold, heat, or microwave energy decreases heavy periods by topically destroying the lining of the uterus, thereby decreasing or eliminating periods. It is done in the office or ambulatory surgery unit by hysteroscopy and there is no incision and a quick recovery. This can only be done in patients who do not desire future fertility, and contraception is a must due to the inability of the ablated uterus to ever safely carry a fetus in the future.
Uterine artery embolization is an interventional radiology procedure where patients with heavy bleeding, especially those with fibroids have a needle placed in the groin localizing the main arteries that lead ultimately to the uterine artery that supplies most of the blood going to the uterus. Continuous xray (fluoroscopy) guides the procedure, and once in the uterine arteries, pledgelets are deployed that interrupt the flow of blood to the uterine arteries, causing the fibroids and uterus to shrink and necrose. This can be very uncomfortable postoperatively, and patients usually stay overnite in the hospital for pain relief and need pain meds over the ensuing week.