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Menorrhagia
Question from VGH on 4/22/2014:

I have been reading the questions/answers regarding ablation and hysterectomy as a means to correct heavy bleeding. I am looking for more clarification I think. I am 46 years old and have had 9 children (ages 17-3) and 2 miscarriages. My husband and I have practiced NFP since we married 18 years ago. For the last few years I have had Menorrhagia. It finally took over my ability to function properly as a mom and I went to the doctor fearful of having to face medicine vs beliefs. I went after my 2nd miscarriage in 18 months. There were no fibroids found and my tests were basically normal. My iron levels were very low and took months of iron supplements to return to a "normal" level. My doctor (knowing my Catholic beliefs) suggestion Lysteda-which is what I found in many of the answers addressed to Dr. Dardano. I have used it for a year and it worked great-until now. My cycles are lasting 7 days (stopping after 5 days with the Lysteda, then starting back up when I go off the Lysteda) and my cycles have gone from 28 days to 21 days in length. My lethargic feelings are returning and I know something new must be done. My doctor ordered bloodwork, ultrasound and biospy this past week. I go next week for results and to figure out the next step. My question is...I know the options she will propose- 1.IUD 2.the pill 3.ablation (after a tubal ligation) and a last recourse after trying the others 4. hysterectomy. #1 is totally out. #2 as well-even if it was not abortifacient, I am on high blood pressure meds that I was never able to get rid of after 2 preeclampsia related pregnancies AND my mother passed away from breast cancer at age 54. #3 does not seem to be a viable choice either. Where do you see my options at this point?

Answer by Judie Brown on 4/28/2014:

VGH

Here is a response to your question from Anthony Dardano, MD

Menorrhagia is a condition which I have wrestled with for years because patients after listening to the media, friends, and a variety of physicians have a moral dilemma with the suggested therapy. At age 46. Whatever the cause might be is further compounded by the approaching menopause. Ovulation is far less regular and the estrogen levels are still elevated. The result is a thickened uterine lining from the estrogen but lacking the progesterone from the egg at ovulation, the lining continues to thicken until it sloughs causing the bleeding outside the cycle.

I agree step one is to evaluate the situation via ultrasound of the uterus and ovary as well as a biopsy of the lining. Certain conditions which are surgically treatable such as a sub mucosal fibroid, an ovarian estrogen producing cyst, or a premalignant lesion in the lining will dictate the therapy.

Once a cause for the menorrhagia is established, an effective, morally permissible therapy can be entertained. Again what is appropriate for you may not be appropriate for someone else. For example, uterine ablation would be acceptable in the celibate, permanently infertile woman but unacceptable in the fertile sexually active patient because of the abortifacient aspect which results post procedure. The IUD of course with its known abortifacient action is unacceptable as well as is the birth control pill.

Aside from the Lysteda and cyclic progesterone therapy,the moral choices are limited. Radical as it may sound hysterectomy is often the best choice. Morally I base my decision on the fact that the condition is detrimental to the patients health and she has failed all conservative attempts to correct the problem. The principle of double effect allows the procedure as a recognized therapy, morally permissible. Furthermore, with the minimally invasive procedures available today, patients go home the next day and the recovery is minimal. My prayers are with you that you make the right decision. Should you have any questions or concerns after you receive the results of your tests I would be happy to help interpret them with you.

Anthony N Dardano, MD, FACS, FACOG

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