Dr. Kathryn Wood, M.D.- gynecologist - Frisco, Texas - annual exams, birth control, hormones, std testing

Abnormal Uterine Bleeding

Many calls to the office revolve around abnormal uterine bleeding, and patients become quite concerned. In this segment, I will attempt to discuss the normal menstrual cycle, and then explain the various causes of abnormal uterine bleeding, along with some treatments available.

In a normal menstrual cycle, ovulation (release of the egg from the ovary) occurs around 12-14 days before the next menstrual cycle. If the egg is not fertilized, then a woman does not become pregnant, and the hormone levels decrease. Estrogen causes a "build-up" of the menstrual lining, while progesterone breaks it down. When these hormones decrease, the lining of the uterus (endometrium) sheds, and the monthly menses occurs.

The cycle begins with the first day of bleeding, and it ends with the first day of the next menses. On average, this is 28 days however; some cycles can range from 21 to 35 days. If the cycles do not occur for 3 months in a row, this is abnormal, and the doctor should be told about this. Many women who are in the mid to late 40's assume they are entering menopause when this happens, but they may just be failing to ovulate.

Abnormal uterine bleeding can also be defined as bleeding between periods, bleeding after sex, spotting anytime in the cycle, and bleeding heavier or longer than normal. It can occur at any age. In a young girl, shortly after menses start, it is common for cycles to be irregular. In a woman 35 or older, the cycle length can shorten normally, and for those around 50, skipping menses and lighter bleeding is fine. However, heavier menses should be checked, as well as cessation of menses with no accompanying symptoms of menopause.

The causes of this can include hormone changes, stress, uterine and cervical abnormalities, medication problems, structural problems such as fibroids, and endometriosis. A physical exam is performed, as well as lab which may include an ultrasound, endometrial biopsy (an office procedure), D&C, hysteroscopy (Operative procedure to look inside the uterine cavity), hysterosaplingography (dye injected into the fallopian tubes and uterus utilizing an X-Ray), Laparoscopy (Operative procedure), and Pap smear.

Treatments involve treating the underlying abnormality. Hormones, such as birth control pills or natural progesterone or progestins may be used. As a physician, the main concern is to rule out endometrial cancer or endometrial hyperplasia which is a pre-cancerous condition of the uterus. Medications such as ibuprofen like meds may be given to control bleeding and relieve menstrual cramping, and some women may need surgery.

Surgical options with D&C and hysteroscopy can involve removal of small fibroids and polyps, as well as perform endometrial ablation, a procedure which can destroy most of the uterine lining. This procedure is outpatient, involves use of a D&C and hysteroscopy with it to visually look at the endometrial lining, and involves some type of thermal damage to remove or ablate the endometrium. The simplest and most effective method I have found is the Novasure, which utilizes radiofrequency energy to heat the endometrial canal to a depth which is determined by measurements within the device. Patients will experience a watery discharge for up to two weeks, cramping the day of the procedure, but a return to work and most activities the next day. For women with a busy lifestyle who don't want the downside of a hysterectomy or the use of medications, this is a viable option.

This procedure should only be done in women who plan on no more children and is often combined with permanent sterilization. It can be done even when a woman has fibroids as the cause of bleeding. One should not do this procedure or any ablation if a woman has a pre-cancerous or cancerous endometrial lining. Also, it is more likely to have long-term effectiveness in a woman in her 40's. Other methods of endometrial ablation include the thermal balloon and rollerball electro coagulation with the resectoscope through hysteroscopy.

If you have abnormal bleeding, please contact our office to be seen and examined, so that a diagnosis and treatment plan can be made to suit your particular medical condition.