Abnormal Uterine Bleeding
Abnormal uterine bleeding can be caused by a number of different things. A normal period typically lasts from 5-7 days and occurs approximately every 28 days. A menstrual cycle is calculated from the first day of your period to the first day of your next period. Things that are abnormal and are reasons to consult your provider:
- Cycles that are shorter than 21 days
- Bleeding between periods
- Bleeding after intercourse
- Bleeding after menopause
- A significant increase in the heaviness of menstrual bleeding
What are some common causes of abnormal bleeding?
- Rapid changes in weight or exercise levels
- Hormonal changes—estrogen and progesterone are not the only hormones that affect the menstrual cycle. Thyroid disease or elevations of a hormone called prolactin (a hormone produced in the brain) can affect periods.
- Uterine fibroids—benign growths that can form in the wall of the uterus, on the surface of the uterus, or within the uterine walls. Uterine fibroids are not associated with an increased risk of cancer and almost never change into cancer.
- Uterine polyps—growths that are formed from the tissue that lines the uterus. They are attached to the wall of the uterus.
- Age—women who are very young and just started periods or who are close to the age of menopause may experience changes in the menstrual cycle varying from shorter periods and lighter periods to longer and heavier periods.
- Endometrial hyperplasia—this describes an overgrowth of the tissue that lines the uterus. These cells can be abnormal and progress to uterine cancer
- Uterine cancer
How do we evaluate abnormal bleeding?
There are a number of different causes of abnormal bleeding. Some of these causes are hormonal, some are structural (changes in the uterus and lining of the uterus), and some can be related to abnormal cells in the uterus. There are several steps that we commonly take in the office to evaluate this. Your doctor will discuss which of the following is appropriate for you based on your history:
- Urine pregnancy test
- Pap smear
- Pelvic exam
- Endometrial biopsy—a procedure in which a small plastic pipelle is inserted into the uterus to obtain a sample of tissue. This is done in the office and typically causes some uterine cramping.
Procedures that are also used for evaluation of abnormal bleeding and performed in the operating room include:
- Hysteroscopy—a small camera is inserted through the cervix into the uterus. Abnormalities of the uterine wall can be easily visualized and abnormal findings, such as uterine polyps, can be removed and treated.
- D&C—formally known as dilation and curettage; an instrument is used to remove tissue from the uterine lining for biopsy
How do we treat abnormal bleeding?
Depending on your diagnosis, your provider may recommend a number of different treatment options. There is not always a clear solution, and for some problems, many different things would work. We have listed treatment options from most conservative to most aggressive below:
This can include the use of medications that contain estrogen and progesterone (birth control pills, NuvaRing) or medications that contain progesterone only (Depo-Provera). These medications can be highly effective for contraception as well as abnormal bleeding or pelvic pain.
The Mirena IUD was originally approved for contraception. However, the FDA has now approved Mirena for the treatment of abnormal uterine bleeding. It is a small T-shaped device that is placed in the uterus in the office. It stays in place for five years and can be removed in the office. Approximately 70% have a reduction in bleeding and 20% experience no further menstrual bleeding.
Novasure endometrial ablation
Novasure is a procedure performed in the operating room at Flowers in the outpatient setting. It is performed in combination with hysteroscopy (described above). Novasure involves removing the lining of the uterus (the endometrium). The procedure is quick and typically takes less than two minutes. It does not involve an overnight stay in the hospital. Most importantly, it preserves the uterus while reducing bleeding in over 90% of patients. Novasure is not an appropriate treatment for women who have not completed childbearing.
Hysterectomy is a definitive option for the treatment of multiple abnormalities responsible for pain and abnormal bleeding. Our physicians are able to offer the most up-to-date hysterectomy procedures including laparoscopic supracervical hysterectomy and total laparoscopic hysterectomy. We have extensive experience and training in performing laparoscopic hysterectomies through three small incisions, each less than ½ inch, with a hospital stay of only one night, and a recovery time of approximately three weeks. Please see “hysterectomy” for more information.