Abnormal Uterine Bleeding and Modern Gynecology

I thought I would write a bit about abnormal uterine bleeding. There are a number of causes, but things basically boil down to two groups:

 Hormonal and Anatomical.

Most hormonal problem bleeding is irregular. Some women will tell me they have never had a regular period in their menstrual life. Some women will develop this in their 30's and 40's after having had normal spontaeous periods. Oh, let's differentiate between spontaneous periods and those on hormones. I am talking about spontaneous periods. Usually irregular bleeding with birth control pills/ Depo Provera/ Mirena IUD and progestin only birth control pills is due to taking the medication. No periods when you are not pregnant also fall into this category.Most irregular bleeding with spontaneous periods is due to hormonal issues. There are four levels where things can go wrong. The uterus, the ovaries, the pituitary gland and the hypothamus. Your gyn will check these depending upon the clinical scenario.

Anatomical abnormal bleeding is generally in the form of heavy bleeding or abnormally light bleeding. This is generally due to problems with the uterus itself. Most of which is benign, but could be premalignant ( precancer ) or malignant (cancer). This includes fibroids, polyps, hyperplasia, cerivcal problems, infections, you get the idea.

Methods of understanding what is going on depends upon the clinical picture, but blind D&;C has pretty much been abandoned as a diagnostic tool. Hysterectomy has been reserved for cancer and large tumors.Ultrasound, saline infusion hysterogram ( "water test"), hysteroscopy and endometrial biopsy help the gyn to diagnose the exact issue, and then target therapy. Some bloodwork may also be done.

Many therapies exist for heavy periods that did not just a few years ago. The use of  agents to induce clotting now has been approved by the FDA and is finding a place to treat those one to two days of heavy bleeding some women experience. The use of a progesterone bearing IUD is another great way to manage heavy bleeding without surgery.Hysteroscopic removal of fibroids and polyps helps eliminate these frequent and specific problems.Uterine Artery Emobolization is a nonsurgical way of treating the heavy bleeding due to fibroids. Some practitoners perform these in the office Endometrial ablation is  a permanent outpatient surgical procedure that has been around in a number of forms for twenty years.. I have never found that to be too comfortable, but recent studies show that most women find the discomfort associated with this as an office procedure acceptable.

The bottom line is that irregular, absent, or heavy bleeding as a problem should not be ignored, and that many specific diagnostic studies are available to target specific therapies.

Until next time....