Abnormal Uterine Bleeding
Many calls to the office revolve around abnormal uterine bleeding, and patients become quite concerned. In this segment, a discussion of the normal menstrual cycle and various causes of abnormalities in the cycle will ensue.
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 range from 21 to 35 days. If the cycles do not occur for 2 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. Remember, ovulation is a sign of health and the lack of it is signaling that something is wrong or needs to be evaluated. The best way to monitor this process is through fertility awareness methods to assess for cervical mucous changes, which ultimately assess for ovulation. These methods can be used to monitor your health throughout your life!
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 woman, 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 a 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 blood work, an ultrasound, endometrial biopsy and/or office hysteroscopy (scope in the uterine cavity), Operative Dilatation and Curettage/Hysteroscopy, hysterosalpingography (dye injected into the fallopian tubes and uterus utilizing an X-Ray), Laparoscopy (Operative procedure), and Pap Smear.
Treatments involve treating the underlying abnormality. At Frisco GYN and Wellness, we look carefully at hormones such as Vitamin D, Thyroid, Insulin Resistance, Cortisol, and Prolactin. Elimination diets can often reduce inflammation in the pelvis leading to menstrual disorders. Exercise can aid with stress and also reduce insulin resistance. Vitamin D is necessary for a good follicle to develop on the ovary, and the thyroid is greatly involved with ovulation and metabolism. Prolactin elevations can cause menstrual problems and infertility problems as well. So, it is important that we treat the underlying root cause of the problem and not just band-aid the problem with artificial hormones.
As always, cancers and pre-cancers must be ruled out. We may utilize some hormones to stop dangerous bleeding and prevent a worsening anemia. Always, it is best to come in early and not let heavy bleeding go on for a long period of time.
If surgery is advised, we will offer you alternatives and choices for treatments. Minimally invasive surgeries are often available.