Condition Abnormal Bleeding

Overview

Some abnormal bleeding can be treated with birth control. More severe cases may require Dilatation & Curettage (D&C), Endometrial resection, myomectomy, or Hysterectomy. At The Center for Innovative GYN Care, our advanced trained surgeons get to know patients before deciding on a treatment option, to choose what is right for the individual.

 

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WHAT IS 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.

WHAT CAUSES ABNORMAL BLEEDING?

Most commonly, abnormal vaginal bleeding is caused by benign abnormalities of the uterus or cervix. Benign conditions include fibroids, polyps, adenomyosis, 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).

Symptoms

SYMPTOMS OF ABNORMAL BLEEDING CAN INCLUDE ANY OF THE FOLLOWING:

  • Bleeding between menses
  • Heavy menstrual flow
  • 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

Diagnosis

HOW IS ABNORMAL BLEEDING DIAGNOSED?

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. Some patients will require cervical or endometrial biopsies to aid in diagnosis. Transvaginal ultrasound is a simple, non-invasive test that will yield a large amount of information regarding the uterus, tubes, and ovaries, and can measure the thickness of the endometrial lining. In post-menopausal patients, the endometrial lining should be less than five mm. The thickness of the lining can vary considerably for reproductive age patients. Hysteroscopy is a useful technique in evaluating the uterine cavity and can identify polyps, fibroids, hyperplastic and malignant lesions. A small camera is inserted into the uterine cavity through the cervical canal, and if polyps or fibroids are identified, they can be removed by hysteroscopic resection. Often, hysteroscopy is followed by dilatation and curettage, if there is no evidence of an obvious abnormality within the uterine cavity. The tissue obtained from curettage is then sent for pathologic evaluation.

Treatment

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.

WHAT MEDICAL TREATMENT OPTIONS ARE AVAILABLE?

Birth control pills which contain estrogen and progesterone are often used to treat abnormal uterine bleeding that is due to hormonal irregularities. Birth control pills have many benefits and are 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) such as Ibuprofen and Naproxen, which are 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.

WHAT SURGICAL TREATMENT OPTIONS ARE THERE?

Dilatation and Curettage (D&C) is the fastest way to stop acute blood loss from the uterus. Those patients with severe bleeding and not responsive to medical therapy should have the procedure done to stop the bleeding. 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 is the destruction of the endometrial lining with thermal energy and should be considered in patients with DUB and have failed 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. Endometrial ablation should only be used in patients who do not desire fertility but desire to retain the uterus. 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.

Patients who are not candidates for endometrial ablation, who are not interested in future child bearing, and who desire a guaranteed cure for their problem should undergo hysterectomy. Hysterectomy refers to removal of the uterus only, the ovaries are not removed. Since the ovaries are kept in place, they will continue to make estrogen, the female hormone. It is estrogen, not the uterus, which prevents patients from going into menopause. For more information on the hysterectomy procedure click here.

Myomectomy, or removal of fibroids while preserving the uterus, is usually reserved for patients who desire to preserve fertility. For more information on the myomectomy procedure click here.

Our Advantage

WHY CIGC FOR ABNORMAL BLEEDING TREATMENT?

When you suffer from abnormal bleeding, it is stressful not knowing why. When the bleeding is severe, it is important to find a GYN specialist whom you trust to avoid further complications. It is a big decision to decide which experts and surgeons to depend on.

Some abnormal bleeding can be treated simply with birth control pills. More severe cases require Dilatation and Curettage (D&C), endometrial excision or resection, myomectomy, or hysterectomy.

Why Not My OB/GYN?

We partner with OB/GYNs. The OB/GYN you visit is likely highly skilled in obstetrics. Minimally invasive gynecological surgery to treat acute abnormal bleeding is a separate specialty that requires advanced fellowship training and extensive practice.

At CIGC, we are completely focused on performing minimally invasive GYN techniques and procedures for optimal care and rapid recovery. Our surgeons specialize in GYN surgery for complications like abnormal bleeding.  While OB/GYNs main focus is obstetrics, our sole focus is advanced gynecological surgery. While the average OB/GYN performs 27 hysterectomies per year, our surgeons average an annual 400. Read stories from our patients to learn more about why our patients trust us.

At CIGC, we explore all of the treatment options, getting to know each patient before deciding on the best approach, so we’re sure to choose the treatment that works best. We also make sure that you are fully informed about the treatment you receive, whether it is a simple prescription for birth control pills or a full D&C treatment, or other surgery.

A safe and speedy recovery is our priority. We have experience with each procedure and have seen all possible outcomes, so we can tell you what to expect to make you feel comfortable.

As a patient, it is your decision where to get treated. As experts in this field, we urge you to visit us and find peace of mind in the form of nuanced expertise and years of experience. If you want to know more about the practices and techniques we employ to treat your abnormal bleeding, please give us a call at (888) 787-4379.

We have offices in Rockville and Annapolis, Maryland, as well as in Reston, Virginia for your convenience.