My period took over my life when I was 35. For 63 out of 80 days, I bled. I was exhausted, anemic, frequently light-headed, occasionally doubled over with cramps, and spending a fortune on tampons. After about a year, my doctor diagnosed me with abnormal uterine bleeding (AUB), defined as excessively heavy periods, bleeding or spotting between periods or after sex, bleeding that lasts more than eight days, or menstrual cycles that are longer than 34 days or shorter than 24. It's often attributed to hormonal issues, or structural abnormalities like fibroids or polyps. As I learned firsthand, treatments range from popping the Pill to undergoing major surgery. If you're one of the millions of women who suffer from AUB, relief starts with knowing your options…

Low-dose versions of the Pill or a progestin-releasing IUD can treat AUB by either ending or regulating menstrual periods. Unfortunately, while the Pill may control the blood, many women (like me) refuse to live with the side effects, which can include weight gain and severe mood swings. And for some women (yes, me again), an IUD may not prevent breakthrough bleeding.

If you don't have a uterine lining to shed, you're less likely to bleed—or so the theory goes, which is why procedures to destroy the endometrial lining have been used for more than a century. Over time, methods of ablation have become more sophisticated. In 1997, the FDA approved a device called Thermachoice, in which a balloon is inserted in the uterus through the cervix and filled with a sterile solution that is then heated. Now the lining can be frozen off (cryoablation), zapped with high-energy radio waves, or burned off with heat-releasing plasma. It may sound like torture, but so is bleeding from Christmas to Easter. And there's not even any cutting or sewing involved, points out Barbara Levy, MD, vice president for health policy for the American College of Obstetricians and Gynecologists. The doctor works through the vagina in a quick outpatient procedure using anesthesia (usually local, occasionally general). Still, even though the reproductive organs are left intact, pregnancy following ablation is dangerous. It's normal to cramp and spot for a few days afterward. Endometrial ablation stops all bleeding 30 to 50 percent of the time—but it has mixed results with adenomyosis, a cause of AUB, in which the endometrial cells migrate into the muscular wall of the uterus.

The surgical removal of the uterus, and sometimes the ovaries, is something many women (and many insurance companies) would prefer to avoid. However, today's procedures aren't our mothers' hysterectomies: Minimally invasive techniques, including the removal of the uterus through the vagina, laparoscopic surgery, and robot-assisted laparoscopic surgery, have decreased major complications like blood clots, nerve and tissue damage, and infections. Patients may have only a few scratch-size incisions, spend no more than a night or two in the hospital, and endure as little as three weeks of recovery. And when all else fails, hysterectomy stops AUB 100 percent of the time. It worked for me.


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