Get back to your life faster. The Center for Innovative GYN Care® world-renowned GYN specialists developed advanced laparoscopic techniques to treat complex gynecologic conditions that can cause abnormal bleeding.
- Revolutionary Techniques
- Return Home The Same Day
- Faster Recovery
Women who have endometriosis, fibroids, adenomyosis, and other complex GYN conditions often suffer from heavy or abnormal vaginal bleeding. Excessive bleeding can lead to complications like anemia. Thousands of women have turned to the CIGC laparoscopic GYN specialists for our state-of-the-art procedures that treat all complex GYN conditions.
When you suffer from abnormal bleeding, it is stressful not knowing why. If the bleeding is severe, it is important to find a GYN specialist as soon as possible to avoid further complications. Some conditions can be treated simply with birth control pills. More severe cases may require an in-office procedure or laparoscopic outpatient surgery, endometrial excision or resection, myomectomy, or hysterectomy.
The CIGC laparoscopic GYN specialist advantage
The CIGC laparoscopic GYN specialists have made a commitment to performing the most minimally invasive procedures with advanced, modern techniques. Even the most complex GYN surgeries at CIGC are performed with exceptional outcomes.
DualPortGYN® and LAAM-BUAO® (laparoscopic assisted abdominal myomectomy) are state-of-the-art techniques that were developed to improve patient outcomes of GYN surgery. DualPortGYN and LAAM® take advantage of advanced surgical techniques that enhance the safety of each procedure.
The CIGC Laparoscopic Gynecologic Techniques
- DRASTICALLY REDUCE SURGERY TIME
- DECREASE THE NUMBER & SIZE OF INCISIONS
- REDUCE RECOVERY TIME & PAIN
- ALLOW PATIENTS TO RETURN HOME THE SAME DAY
Abnormal bleeding causes
Conditions that cause abnormal bleeding
Most commonly, abnormal vaginal bleeding is caused by benign abnormalities of the uterus or cervix. Benign conditions include fibroids, endometriosis, adenomyosis, polyps, and infection.
Occasionally, malignant and premalignant conditions are the cause of abnormal bleeding. Such conditions include endometrial hyperplasia, endometrial carcinoma, and cervical carcinoma.
Systemic conditions such as bleeding disorders, liver disease, pregnancy, and some medications such as oral contraceptives can cause irregular bleeding.
Hormonal disorders such as PCOS (polycystic ovarian syndrome), premature ovarian failure, thyroid and pituitary abnormalities can also cause abnormal bleeding.
When no organic cause of abnormal bleeding is identified, the patient is diagnosed with dysfunctional uterine bleeding (DUB).
What are the symptoms of abnormal bleeding?
The normal interval between menstrual periods is 21 to 35 days. Most women have a duration of flow of no more than seven days, and lose no more than 80 cc (or 2.8 ounces) of blood with each cycle. Women with an interval less than 21 days or greater than 35 days, with menstrual flows greater than seven days’ duration, or with more than 80 cc of blood loss have abnormal bleeding.
- Abnormal period, bleeding between menses
- Heavy menstrual bleeding
- Large clots
- Menstrual flow lasting longer than seven days
- Any bleeding after menopause
- Any bleeding after intercourse
- Interval between periods lasting greater than 35 days
- Only having four to nine periods in a year
Gyn conditions that cause abnormal bleeding are diagnosed in multiple ways
The patient’s age as well as the pattern of abnormal menstrual bleeding is extremely important in identifying the cause.
Careful history is obtained to evaluate the frequency and the amount of bleeding.
Blood tests such as blood count, clotting factors, and iron levels can also be helpful in diagnosis and can identify the patients who need to be treated with iron supplementation.
Physical exams are performed to identify cervical or uterine masses or lesions.
- Cervical or endometrial biopsies
- Transvaginal ultrasound
- Hysteroscopy (A small camera is inserted into the uterine cavity through the cervical canal)
- Dilation and curettage
Measuring the thickness of the endometrial lining is an important test. In post-menopausal patients, the endometrial lining should be less than 5 mm. The thickness of the lining can vary considerably for reproductive age patients.
What are the treatment options for abnormal gyn bleeding?
Treatment of abnormal uterine bleeding is based on the underlying cause of bleeding. Patients with DUB are usually treated with medical therapy, since there is not a specific lesion (organic cause) amenable to surgical therapy. Those who fail medical therapy should consider surgical options. Patients with anatomic causes of abnormal bleeding such as fibroids, polyps, or cancer are managed with surgical therapy. If a systemic (liver disease) or hormonal condition (thyroid disease) is the cause of abnormal bleeding, treatment of that condition will usually resolve the abnormal bleeding.
Surgical Treatment Options
Hysterectomy: Patients who are not interested in future child bearing, and who desire a permanent solution to abnormal bleeding should consider a laparoscopic hysterectomy.
In most cases, hysterectomy refers to removal of the uterus only. At CIGC, frequently, the cervix and fallopian tubes are also removed. If the ovaries are not removed they can continue to make estrogen, the female hormone. This can prevent patients from going into menopause. Learn more about the DualPortGYN hysterectomy.
Myomectomy: A laparoscopic myomectomy preserves fertility while removing fibroids from the uterus.
A CIGC LAAM myomectomy is an advanced technique that makes it possible to have a thorough fibroid removal with a rapid recovery. Learn more about the LAAM myomectomy.
Dilation and Curettage (D&C): D&C is the fastest way to stop acute blood loss from the uterus. Patients with severe bleeding who do not respond to medical therapy can have a D&C procedure to stop the bleeding. However, D&C provides only short-term relief from DUB. Medical therapy should be instituted after the bleeding has been controlled. Hysteroscopy at the time of D&C may help identify an organic cause of bleeding, such as a uterine polyp or fibroid, which can be removed during the same procedure.
Endometrial Ablation: Ablation is the destruction of the endometrial lining with thermal energy and should only be used in patients who do not desire fertility. This approach can be considered for patients with DUB and have not experienced success with medical therapy. Energy-delivering devices include cryotherapy, circulating hot fluid, thermal balloons, radiofrequency electrosurgery, microwave energy, and diode laser energy, as well as monopolar and bipolar devices. This can be performed in the office with local anesthesia and IV sedation or in the operating room with IV sedation or general anesthesia.
Who Should Not Have Endometrial Ablation: Patients with multiple and/or large fibroids or patients with other organic causes of abnormal bleeding (such as adenomyosis) should not undergo this procedure. An 80 percent success rate can be achieved in select patients. Twenty percent of patients will require either another ablative procedure or hysterectomy.
Medical Treatment Options
Birth control pills: Birth control pills contain estrogen and progesterone and are often used to treat abnormal uterine bleeding that is due to hormonal irregularities. This treatment has many benefits and can be safe for long-term use. Progesterone-only pills and intrauterine device (IUD) are used in women with thickened uterine lining. Progesterone keeps the lining thin and can prevent the development of hyperplasia and uterine cancer.
Non-steroidal Anti-Inflammatory Agents (NSAIDs): Medications like Ibuprofen and Naproxen given for the duration of menstrual bleeding have been shown to decrease blood loss during the menstrual period. NSAIDs are more effective when combined with birth control pills to control bleeding.
DualPortGYN Minimally Invasive Technique For All GYN Conditions
The state-of-the-art techniques used in the DualPortGYN surgeries create a safer procedure so that women can have surgery and return home the same day. Laparoscopic procedures that can be performed with DualPortGYN include hysterectomy, endometriosis excision, ovarian cystectomy and other minimally invasive GYN procedures.
The CIGC minimally invasive specialists are able to perform complex surgeries while ensuring the patient has an exceptional procedure with fast recovery. After a DualPortGYN laparoscopic GYN procedure, Most patients can return to normal activity, including work and school, in about 1 week. All patients should follow the recovery recommendations specifed by their surgeon.
A Safer Minimally Invasive GYN Surgery
LAAM Minimally Invasive Fibroid Removal for Fertility – An Advanced Laparoscopic Myomectomy
The CIGC state-of-the-art LAAM procedure is one of the most advanced fibroid removal techniques available for maintaining fertility. This procedure is only performed on women who are able to maintain fertility.
LAAM candidates are:
- Women age 45 and younger with fibroids who are able to maintain fertility.
- A woman’s age is the single most important factor affecting her fertility. Fertility decreases exponentially after 40. (Age 40, the chance of conceiving is about 5%. At age 43-44 the chance of conceiving with IVF is 1%.)
- A myomectomy is not recommended for women who are unable to maintain fertility or who are no longer interested in childbearing.
- There is a higher risk of a patient needing future surgery after a myomectomy, exposing them to additional anesthesia, additional recovery time.
- If childbearing is no longer possible or desired, a hysterectomy for fibroids is a cure, eliminating the need for future surgery.
- Women with fibroids who have pre-arranged for a donor egg or IVF options.
- Depending on the viability of the uterus, it is possible for some women over the age of 45 to conceive with IVF or with donor eggs.
- These arrangements must be made and confirmed prior to consulting with a CIGC surgeon.
LAAM makes it possible to remove small and large fibroids while preserving the uterus using just two small incisions. LAAM is a hybrid technique that combines the best of laparoscopic and open myomectomy procedures. The incisions are small (one 5 mm incision at the belly button, and one 3 cm incision at the bikini line) and the fibroids are thoroughly removed.
The combined techniques retroperitoneal dissection, uterine artery ligation/occlusion, and strategically placed incisions set LAAM apart from all other fibroid removal techniques. The CIGC specialists use these advanced techniques to ensure a safe, thorough and effective procedure, and recovery is fast. Most patients can return to normal activity, including work and school, in about 10- 14 days. All patients should follow the recovery recommendations specified by their surgeon.
- The smaller incisions help with faster healing, compared to open or robotic procedures that have longer recovery times. Robotic procedures can take up to 4 weeks for recovery. Open procedures can take up to two months for recovery.
- The lower incision allows the surgeon to feel all of the fibroids in the uterus for a thorough procedure. It is important to remove all of the fibroids from the uterus. If fibroids are left behind, they can grow and continue to cause problems, which may result in the patient needing additional procedures.
LAAM techniques outperform other standard laparoscopic techniques. Non-LAAM laparoscopic myomectomy procedures can leave fibroids behind, either because they are small and missed by the surgeon, or because blood loss is not well controlled and the procedure has to be stopped for the safety of the patient. Open procedures can cause long painful recoveries, and create extensive pelvic adhesions. Myomectomy procedures that do not use RP Dissection or Uterine Artery Ligation have higher risks of complications.
NOTE: LAAM minimally invasive myomectomy is performed on women who are able to maintain fertility. When fertility is no longer a viable option (1% or less), and fibroids interfere with day-to-day activities, a myomectomy is not recommended due to the potential for the need for future surgery. With any myomectomy procedure, fibroids can return. Performing fibroid removal alone (a myomectomy), versus removing the uterus (hysterectomy), when fertility is no longer possible increases the risks to the patient. Women 45 or over, unless they have arranged to have a donor egg prior to having fibroid removal, should consider the benefits of a hysterectomy to ensure fibroids do not grow back.
Trying to conceive
Patients are required to wait a minimum of six months after myomectomy before trying to conceive. The internal layers of the uterus must heal properly. This is essential for ensuring a safe pregnancy. All patients should follow the recovery recommendations specified by their surgeon.
Advanced laparoscopic gyn surgery techniques make it possible to return home the same day & recover faster
At CIGC, controlling blood loss and improving visibility make it possible for our advanced laparoscopic GYN specialists to perform minimally invasive outpatient surgery for complex GYN conditions that may normally be performed as open procedures by non-laparoscopic surgeons.
The incisions used for the CIGC surgeries are very small, and placed in the midline, away from the abdominal muscles. The size and placement of these incisions allows patients to feel better faster.
CIGC never uses electronic morcellation techniques with any of its procedures, including the DualPortGYN technique for hysterectomies as well as for removal of fibroids during myomectomies.