Heavy Menstrual Bleeding: Causes, Treatments & When to Seek Help

Question
Hi,

I'm a 21 year old woman with no children who has been seeking help for extremely heavy and painful menstruation for years now. I have tried several types of pills, Depo-Provera, and Nuvaring for ongoing contraception, none of which had any effect on my periods. I have been treated as well with Aygestin during periods that were 2+ weeks long, which did not stop the bleeding.

For the last few years my periods have lasted 8-15 days and for at least 5-6 of these days I bleed so heavily I use an overnight maxi every 1-2 hours. I have been prescribed Wygesic for pain control as no OTC analgesic has reduced the cramping enough for me to function.

I have had a complete GI workup with nothing notable besides IBS (which is under control), a laparoscopy four years ago that showed no evidence of endometriosis, a recent ultrasound that showed nothing abnormal, and a recent D&C/hysteroscopy of which the only result I was given was that my uterus was "thickened".

My question is not "what's wrong" becuase I know this is not an appropriate medium for that, but I am wondering if my doctor's recommendation to just "wait and see" what happens over the next few years is the most appropriate option. I am losing a full week of my life to my period every month, as I cannot even leave the house between the pain and practically having to pack a backpack with pads and a change of bottoms (as I frequently bleed much faster than a pad can absorb, leading to spillage).

I know I am young, and I know that many of the solutions to this are not ideal for someone at pre-childbearing-age, but are there any other paths I could be asking my doctor to pursue?

Thanks for your advice.

Answer
If you have tried several different birth control pills, Aygestin, and Depoprovera to no avail, you may need a hysteroscopy to assess your endometrial cavity and to distinguish if your bleeding is hormonal, due to irregularities in your uterus (fibroids or polyps), or some other cause. If all else fails, you may need to have ablation of your endometrium to stop the bleeding or ligation of your arteries to lessen the flow each month.