Heavy Periods & Mirena: Seeking Second Opinion - Symptoms & Testing

Question
Thanks in advance for your time. I am just looking for another opinion regarding my situation. I am a 35 year old woman.  I have carried 2 healthy pregnancies, my youngest child is 3.  Over the course of the last year, my periods have gotten very, very heavy and last almost 7 days with the first 3-4 days unbearable.  I recently consulted with my OBGYN and was put through a lot of testing.  Blood tests, ultrasounds, pap smears and biopsies.   Every thing came back normal
with the exception of low iron stores (obviously a result of the heavy bleeding) I have not been on any type of birth control in at least 7 years.  My doctor recommended Mirena.   I had the Mirena in for 6 weeks before I had it removed.  I had an awful experience with it as it increased my anxiety and contributed to horrible insomnia. I felt awful while on the Mirena.  Since having it removed (3 days ago) I have had pretty heavy bleeding, similar to a period, though not quite as heavy as my normal periods.  When the nurse removed the mirena I was a little more than half way into my cycle and she said I shouldn't expect to bleed much.  Obviously there is something going on with my body that is not quite normal.  Since the doctor was not able to find a cause of my heavy periods, they deemed it dysfunctional bleeding.  I just feel like there has to be a cause.  Do you have any thoughts or suggestions?

Answer
The 2 most common causes of heavy periods are dysfunctional bleeding and fibroids (benign uterine tumors).  Sometimes fibroids can be small and be missed by an exam and even an ultrasound.  Dysfunctional bleeding generally means hormonally caused, and usually responds well to hormones.  This could be birth control pills or progesterone pills given periodically to bring on a period and prevent buildup of the uterine lining.  Since they haven't found fibroids with the testing, I would suggest 1-2 months of birth control pill.  If that causes your periods to be normal, that would confirm that the heavy periods are from hormonal causes.  If not, then there are special studies (sonohysterography or hysteroscopy) that could detect small fibroids.  If you don't plan on having more children, you might consider endometrial ablation, which destroys the uterine lining and stops heavy periods, regardless of the cause.