45 and Heavy Periods

Question

I’m a 45 year old mother of six. My husband and I practice NFP. For a long time, my periods have been very heavy and lasted eight to ten days, with older, darker blood the last few days. The spacing varies between three weeks and eight weeks over the last year.
I went to a military GYN last week to ask about possible treatments. The ones she offered were: ablation (no, I might be still ovulating so I don’t want to ruin my uterine lining in case we conceived); Prometrium; or Provera. I’ve looked online and found out that Provera seems to be a BCP, so I don’t want that. Prometrium has many warnings for health risks.

Are there any safe treatments for this or am I just to manage as best I can until menopause? She’s going to perform a endometrial biopsy on Tuesday, after a pregnancy test, to see if there is anything wrong.

Julie

Answer

Dear Julie,

There is a significant possibility that your heavy bleeding could be helped by progesterone, especially if an ultrasound, biopsy or other studies have ruled out precancerous conditions, polyps or fibroids. In a normal menstrual cycle progesterone levels are higher in the latter part of the menstrual cycle. These drop after age 35 or 40. Progesterone supplementation day 16 through 27 of the cycle or (if you are doing NFP charting) three days after ovulation through ten days after ovulation can significantly improve bleeding. This therapy replaces the missing natural hormone. It will NOT hurt an existing pregnancy, and diminishes the possibility of miscarriage if you conceive.

One issue is the form of progesterone to supplement. Prometrium is a prescription form of bioidentical progesterone, identical to what is in your own body. It does NOT cause cancer or blood clotting. FDA regulations force manufactures of bioidentical progesterone to put these complications in the package inserts because SYNTHETIC progestins (NOT propgesterone but compounds chemically related to progesterone) cause these problems. Provera causes breast cancer, depression, increases inflammation and decreases oxygen flow to the heart; progesterone has NONE of these effects. Progesterone is your own body’s hormone and does NONE of these things. The only common side effect of Prometrium, which is an oral progesterone pill, is sleepiness. This can be bypassed by taking the pills at bedtime. There are a small number of women, less than 5%, who do not metabolize Prometrium well and feel dizzy, foggy and have headaches.

An alternative and more effective route to help heavy bleeding that will prevent side effects of oral progesterone is to take it vaginally. There are prescription vaginal preparations of progesterone such as Crinone that can be used in the latter part of the cycle. I prefer prescribing a 10-12 day course of progesterone vaginal capsules of 600 mg. that can be made to order from a compounding pharmacy. Kubat pharmacy in Omaha makes 600 mg capsules (800-702-9988). Other compounding pharmacies make 400 mg. capsules. Prometrium contains 200 mg. of progesterone and can be used vaginally, but higher doses are more powerful and work better for heavy bleeding. However, sometimes after three months or so of high dose vaginal progesterone you can switch to lower dose vaginal or oral progesterone and that might be enough to prevent symptoms.

Mary Davenport, MD

Answered By:

Mary Davenport, MD, MS
Mary Davenport, MD, FACOG, an obstetrician/gynecologist from the Oakland Region of California, offers telehealth services over MyCatholicDoctor.com She graduated from Tufts University School of Medicine and completed her residency at UC San Diego. Dr. Davenport is a Fellow of the American College of Obstetrics and Gynecology, and serves on the Advisory Board of the California Association of Natural Family Planning.

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