Abnormal Uterine Bleeding — St. Mark’s Center for Women’s Health


– Abnormal uterine bleeding can refer to either heavy menstrual periods or bleeding that happens
in between periods. Any bleeding in a woman who is menopausal and not on a hormone therapy is abnormal, and we need to investigate that and figure out why it’s occurring. In women who are on hormone therapy, we still need to evaluate that, although most commonly that’s related to the hormone therapy. To evaluate abnormal bleeding in a woman who is postmenopausal, we rely
on sampling the endometrium to obtain tissue from
the endometrial cavity and send that biopsy to a
pathologist to make sure about issues related to
endometrial cancers or pre-cancers. Abnormal bleeding that happens
in a postmenopausal woman is related to endometrial cancer
only about 10% of the time. But when that bleeding occurs, that’s sort of the thing
that you need to make sure that it’s not related to endometrial or uterine lining cancer. Treatments for abnormal uterine bleeding will be sort of age-dependent and based on the severity of it. If it’s very mild, sometimes
observation is okay. But for women who need treatment, there’s a range of therapies
from birth control pills, which may be given cyclically, or we might consider a
progesterone-releasing IUD, what’s called the Mirena IUD. Another option that’s available
is endometrial ablation. With endometrial oblation,
a device is advanced through the cervix and
into the uterine cavity, and contact is made through
the whole endometrial cavity to bring energy of some sort. In the case NovaSure,
it’s radio frequency. But the idea is to destroy or damage those endometrial glands so
that they can’t regenerate. So a woman will maintain
her normal ovarian function. She’ll still have hormonal
function just as she did before, but there’s just no response
with this uterine lining to build up and have a period each month, or the period is greatly diminished. So, fibroids can happen in the
muscular wall of the uterus, and they can even be pretty large as long as they’re not
close to the interior wall of the uterus and really
not cause a problem. But if the fibroid is close to the inside lining of the uterus, what’s called a submucosal fibroid, then it interferes with
that uterine lining, sort of squeezing off
and the glands closing when she’s trying to stop
bleeding with a period. And these kind are the ones
that will cause problems. Abnormal bleeding is such a common problem in women throughout their
reproductive age range and into their menopausal years even and can be a source of such frustration. But the good news is that
we have lots of therapies that we haven’t had in the past. We just need to evaluate the
cause of why it’s happening, and they can offer those women a choice about how they prefer to be treated.

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