The following are some of the causes that could be associated with abnormal uterine bleeding:

• Ovulation
• Medications
• Intrauterine Devices
• Vaginal, cervical or uterine infection
• Cancer
• Hormone imbalances
• Fibroids, polyps or adenomyosis
• Pre-existing bleeding disorders
• Trauma

• Periods that last longer than 7 days
• Menstrual flow that soaks through one or more tampons or napkins every hour for consecutive hours
• Menstrual flow that often includes large blood clots
• Fatigue or shortness of breath during your period
• Bleeding between periods
• Continuous and irregular bleeding without obvious menstrual cycles
• Postmenopausal bleeding

Endometrial ablation
A minimally invasive treatment, endometrial ablation utilizes lighted viewing instruments along with others to destroy (ablate) the uterine lining, or endometrium. The procedure can be performed using a variety of methods including, a laser, heat, electricity and freezing. Generally, patients require only local or spinal anesthesia and recover in a few days. The endometrial cavity heals by scarring. The absence of functional endometrial tissue reduces or prevents future uterine bleeding. Endometrial ablation reduces the menstrual flow of about 90% of women and up to half of the affected women will stop having periods all together.

Good candidates for endometrial ablation are women who:

• are not responding to other treatments
• have completed childbearing
• are not able to or prefer not to have a hysterectomy
• do not have large polyps or fibroids causing the bleeding.

Younger women are less likely to respond to this treatment and require a repeat procedure. Endometrial ablation is not a good option for women with postmenopausal bleeding.

Operative Hysteroscopy
In women with intracavitary (submucous) fibroids or polyps, removal of these anatomic abnormalities is the best treatment option. Often this can be accomplished using a camera (hysteroscope) through the vagina and cervix. When possible, this procedure is performed on an outpatient basis with patient's returning to normal activities within 1-3 days.

Progesterone-containing IUDs
An intrauterine device (IUD) with progesterone typically reduces bleeding by up to 80% in women with heavy bleeding. The IUD is placed into the uterus through the vagina and cervix. This usually is done at your doctor's office. The hormonal effects are local and therefore do not cause the side effects of systemic hormonal therapy. Progesterone-containing IUDs can be used in women who desire future childbearing.