One of the most common gynecologic issues is abnormal uterine bleeding. Abnormal uterine bleeding typically presents itself in two ways:
- As heavy periods, known as menorrhagia
- Bleeding at unexpected times, such as before or after a women's normal menstrual cycle
Abnormal uterine bleeding is more likely during puberty and among premenopausal women who are experiencing erratic hormone levels. In women 40 years and older, it also may be a sign that a women is entering perimenopause. Pregnant women and postmenopausal women should always discuss abnormal uterine bleeding with their doctors immediately. The following are some of the causes that could be associated with abnormal uterine bleeding:
- Intrauterine devices
- Vaginal, cervical or uterine infection
- Hormone imbalances
- Fibroids, polyps or adenomyosis
- Pre-existing bleeding disorders
While the symptoms of abnormal uterine bleeding may be obvious, your physician will also consider the following when determining the cause and severity of your condition:
- 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
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Treatment options for abnormal uterine bleeding range from observation to drug therapy or surgical intervention if necessary.
A minimally invasive treatment, endometrial ablation uses 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 percent 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 unable 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.
In women with intracavitary (submucous) fibroids or polyps, removal is the best treatment option. Often performed with a camera (hysteroscope) inserted through the vagina and cervix, the procedure can be done on an outpatient basis with recovery in one-to-three days.
An intrauterine device (IUD) with progesterone typically reduces bleeding by up to 80 percent in women with heavy bleeding. The IUD is placed into the uterus through the vagina and cervix typically in a doctor's office. The hormonal effects are local and do not cause the side effects of systemic hormonal therapy. Progesterone-containing IUDs can be used in women who want to become pregnant.