The BetsyG-Spot

Men, you are welcome to read this, but it’s about periods and being perimenopausal. You’ve been warned.

By Betsy G

My periods have never been a problem. Unlike some of my friends who were felled by them each month, I endured a single day of not pleasant, but not debilitating cramps, which could be held at bay with ibuprophen. My cycle was pretty regular, too, at one point coming every 28 days on the nose. It was sometimes longer, never shorter.

In my mid-30s, things started to change. I was still regular, and my cramps were the same as ever, but I started to spot for up to a week before my period. After I had an endometrial biopsy to rule out any other explanation for this change, I learned this was a sign of being perimenopausal, a state you apparently can be in for a very long time. (I don’t know why they don’t just call it “premenopausal.”)

Before I continue, I do want to state that no matter how educated I may sound about these matters, I do not have a medical background. This is a report of my experience. If you have irregular or heavy bleeding, consult your doctor. Obviously make your choices about birth control and other gynecological issues based on your own experience and your physician’s recommendations.

As I made my way through my 40s, the changes became more pronounced. The cramps got much worse, what I would call “eye-crossingly” bad. I don’t know if that brings it home for you, but I don’t have a better way to describe the pain. The further I got into my 40s, the worse the cramps were, and the heavier the bleeding. When I was younger, in contrast to friends who used two super tampons at a time (I could not quite imagine that), I managed to get by with a medium every four hours or so on the first day. Now I was going through a tampon every hour or two. My periods recently started coming more frequently, with three-week cycles becoming less and less of an anomoly.

By the time I went to the gynecologist to see what could be done, it seemed as if I was either spotting or having a full-on period all but one week of the month. I was so exhausted by the combination of blood loss and cramps, I was losing two days a month to my period; all I could do was lie on the couch, barely able to think a thought, let alone write anything worth being paid for.

I mentioned all this to my gynecologist, and she at first suggested the pill, which is given to perimenopausal women to keep their cycles regular and also to provide good birth control at a time when getting pregnant is still possible but ovulation is irregular. I had been on the pill in the past, though, and it didn’t agree with me. I experienced essentially every possible side-effect: breakthrough bleeding, moodiness, aching breasts, and lack of libido (and what’s the point of that?). I wasn’t interested in going that route again.

Then my doctor suggested the Mirena IUD. I had never found the idea of having a device inserted into my cervix very appealing, but she gave me the brochure and explained how it worked. Unlike a traditional IUD, the Mirena time-releases the hormone progestin over five years. She explained that this would thin the uterine lining, reducing flow and cramps and potentially eliminating menstrual bleeding altogether. She often prescribed the Mirena to ease women into menopause, so that rather than having years of irregular periods, they might not have to experience bleeding at all on the road to the completion of menopause. Plus Mirena has the same benefit as the pill, providing reliable birth control when ovulation is unpredictable. (Mirena, of course, has the same birth-control advantages as any IUD…you don’t have to remember to take anything, and it’s highly effective.)

This sounded intriguing. I wouldn’t be using Mirena as birth control as much as I’d be using it to fix my monthly problem. Indeed, my doctor regularly prescribed it solely for the purpose of reducing flow and cramping, which was really what I was looking at it for. I took the brochure and said I’d study it and read up to better understand the risks and side-effects.

The side-effects sounded minimal, and the brochure said I was likely to experience them in the first few months if at all. Possibilities included: intermittent bleeding, breast pain, depression, acne, cramping, and headaches. Among the risks were perforation of the uterus. (Do read their web site for complete and accurate information.) My gynecologist all but guaranteed I would have annoying spotting for up to six months following insertion.

I was thinking on it. I had a lot going on personally and wasn’t sure I wanted to make any changes that would affect my chemistry. I read horror stories online by dissatisfied Mirena customers, most of whom were very young, I noticed, and who had not had any children, and Mirena is recommended for women who have had at least one child. (Fertility does bounce right back after the Mirena is removed, according to the literature.) The women in the forums also found the insertion painful, the bleeding and cramping miserable, and many experienced depression.

While I was still considering it, my next period came. Besides the usual exotic cramping, the blood flow was unusually heavy. At one point blood was literally pouring out of me, and I soaked through a tampon for the first time ever. The idea of having another period was becoming frightening. A friend had experienced something similar—progressively heavy bleeding—and she ended up in the emergency room due to blood loss during her period. That turned out to be her last period before she had an endometrial ablation, a procedure in which the uterine lining is removed. Endometrial ablation has the same positive effect as the Mirena, reducing the blood flow and cramping, but it does not prevent pregnancy. (In fact, becoming pregnant after endometrial ablation is dangerous.)

Knowing that things could get that bad, I decided I’d better do something. The Mirena seemed a better alternative to endometrial ablation for my case because it wasn’t surgical. As for the complaints I’d read about Mirena, I decided that usually it’s the whiners who write on the forums, and I’d take my chances. If it was that bad, I could have it removed, and maybe then consider endometrial ablation.

And so, after the results of the screening tests came back negative (pelvic inflammatory diseases such as chlamydia are a problem with Mirena…which is probably why it’s not recommended for women who have multiple partners), I made an appointment to have the thing inserted.

Despite the warnings in the forums, I didn’t expect the pain to be that bad because I’d had the endometrial biopsy in the past and, while it wasn’t like eating a bowl of ice cream, it wasn’t as bad as, say, labor. The insertion was bearable, though there was one jolt of pain that had me feeling faint for quite a few minutes afterward. (As you can see from this picture I took in the office, I was a bit green.) I did bleed and cramp a bit in the days following, but I was just going into my period so it was hard to tell how much of it was period cramping and how much of it was Mirena cramping.

After my period, I had intermittent spotting and occasional cramping, but I kept my eyes on the prize of ultimately having reduced flow. As the month wore on, both symptoms improved; the only other symptom I experienced was breast pain.

I began to look forward to my next period with great anticipation (a first).

Then I got my period, and what a difference! I wasn’t even sure if it was my period. The cramps were faint, the blood flow was light…I couldn’t have been happier with the result.

After my period, I expected to continue spotting as my gynecologist said I would. But I have not had any spotting—or cramping—since my last period. The only side-effects I have experienced are a slight issue with depression (my bugaboo anyhow), maybe a headache or two, and aching breasts. I am hoping the breast pain will go away once I get my next period, but I am certainly willing to put up with it as a trade-off for lighter flow and less cramping.

So yay for Mirena! It’s already made a huge difference, and the side-effects have been minimal. If you’re in a similar situation, I recommend you discuss this option with your physician.

August 18 update
My next period was a breeze. It went on for a little longer than usual, but the flow was light, the cramps were handled by two doses of ibuprophen (as opposed to popping pills all day long), and I had no difficulty working. I can’t believe the difference it’s made.