Per my last column, I went through the highly unpleasant experience of getting a uterine (or: endometrial) biopsy, in order to rule out “bad things” (or: cancer) before deciding what course of action I might want to take to try to manage my over-enthusiastic menstrual bleeding (or: TsunamiPeriods).
Backstory: We’ve already tried having me on the mini-pill for the past 8 months or so, which seemed to be helping until May became the month my period would not stop (24 days straight bleeding when all was said and done). Hence my asking what to do. Hence the biopsy. Of course, then June became the month my period did not come at all, and I’m currently on day 44 without a period. But with PMS for much of that time.
Oh, wacky, wacky peri-menopause.
Bad things properly ruled out (#blessed), these were the three options my gynecologist laid out for me. Spoiler alert: None sound perfect or will magically “fix” everything.
Option #1: Another IUD
I had an IUD, and for nearly six years this was a little slice of reproductive heaven. After the first six months, my period stopped, and my doctor was hoping that IUD would last me until I was in/past menopause. No such luck. It hit its seven-year lifespan, with my periods getting worse and worse and worse. So, option #1 is to insert another IUD and go for several years of period-free bliss and hope (again) that it will last until I’m in menopause.
PROs: Pretty good experience with an IUD in the past, as far as controlling my period. Did not notice particular side effects.
CONs: Putting the IUD in is a little uncomfortable. Taking it out was very unpleasant…maybe not quite as unpleasant as the biopsy, but non-trivial. In fact, I tried the mini-pill and was hoping it would do the trick when my first IUD sputtered out, so I wouldn’t have to put another one in or take it out.
Option #2: An ablation
An ablation basically cauterizes the inside of your uterus, leaving you with no uterine lining to respond to hormonal changes begging it to shed. I’ve heard from people who said it fixed their symptoms around bleeding immediately, and they wished they’d done it sooner. I’ve also spoken to people who found it very very painful. Pain is certainly one concern, but my biggest concern is something my doctor shared with me about having an ablation may make it very difficult to diagnose any future problems with bleeding. She’s had patients who ended up having hysterectomies in their 60s because they could not perform a proper biopsy or even get a camera past the scar tissue, which certainly sounds dramatic.
PROs: Chances are this absolutely stops my periods.
CONs: It may potentially complicate diagnosing and resolving future medical problems. And it will probably be at least a little painful.
Option #3: A Lupron injection
Lupron shuts down estrogen and testosterone production and is commonly used as part of an infertility treatment protocol, to delay puberty in trans youth, and, yes, to try to treat endometriosis and uterine fibroids (of which I have a couple). According to my doctor, you only really use Lupron for six months (and it looks like that’s because there can be pretty severe side effects with longtime use). So, the hope would be that after six months of artificially shutting down my estrogen production, my body would cooperate and kick into menopause.
PROs: I am really not sure what the PROs are, except that an injection is easier than messing about inside my body. Even so, this seems like a path I could immediately reject. Because…
CONs: I can’t imagine why I’d expect my own body to be ready for menopause in six months. Just to get more information I had more blood work done, and apparently, my FSH hormone values are those of younger menstruating woman. In other words: My lady hormones are super youthful. Yay?
I’m obviously not a doctor, but this is how I, the patient, understood the options my doctor laid out for me.
Given my Youthful Lady Hormones (that’s my new band name, by the way), I’m leaning hard towards getting another IUD.
But in the meantime, I might as well wait out this next period…44 days and counting…and see how bad it is to remind me why I want to do anything else with my poor uterus at all.
Which would you choose?
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