Prolonged heavy period

[diraswan]

Hello Dr. Briden!
Ever since starting my period in my teenage years, it has been extremely heavy and painful. I would bleed very heavily nonstop for months. Then my period would vanish for a month or two and it would repeat. This led to anemia, iron pills and a blood transfusion. I was diagnosed with PCOS at 19 due to elevated androgens. With limited options, I was on the pill for many years. Now I'm 26, and have been off the pill since May 2021. I have been bleeding heavily for 6 weeks now. Any advice on the best way to manage this?

[Lara]

Have you been screened for Von Willebrand Disorder? See the article The Overlooked Cause of Abnormal Menstrual Bleeding.

For the heavy, irregular bleeding of PCOS specifically, see my blog post Cyclic progesterone therapy for PCOS.

[diraswan]

I'm currently on the pill again to control the bleeding but having severe cramping and still breakthrough bleeding. I did a transvaginal ultrasound and my lining was 30 mm thick so I did a biopsy which was normal. My OBGYN wants to do a D&C. I just want to get off the pill but stop the bleeding and prevent the lining from building up again. Still have not been tested for Von Willebrand but my thyroid hormones came back abnormal. High T3 and low T4 I believe.