Monthly Cycle Issues -- November 3, 2008 -- Dr. Naomi Paschall - | Nashville News, Weather & Sports

Monthly Cycle Issues -- November 3, 2008 -- Dr. Naomi Paschall


Medical Mondays
November 3, 2008
Monthly Cycle Issues & Abnormal Menstrual Bleeding

Abnormal menstrual bleeding

Dysfunctional uterine bleeding is a term for vaginal bleeding that either occurs between a woman's normal menstrual periods or in abnormally large amounts during her period.

In most cases, women who have abnormal bleeding do not ovulate (release an egg from their ovaries) during their menstrual cycle. This causes a hormone imbalance where the estrogen in your body makes the lining of your uterus grow until it gets too thick. When your body gets rid of this lining during your period, the bleeding will be very heavy. A hormone imbalance also may cause your body not to know when to shed the endometrium. This can cause irregular bleeding between your periods.

Abnormal bleeding caused by a hormone imbalance is most common among teenagers who are just starting their periods or women who are going through menopause.

In some women, fibroids (benign tumors) or polyps (fleshy growths) of the uterus can also be the cause of abnormal bleeding. In rare cases, it can be caused by endometrial cancer (cancer of the lining of uterus) or cancer of the uterus.

What are the treatment options?

There are several treatment options for abnormal bleeding, depending on the cause of your bleeding, your age and whether you want to get pregnant in the future. Your doctor will help you decide which treatment is right for you. Some of the treatment options include the following:

Birth Control Pills
Birth control pills contain hormones that can stop the lining of your uterus from getting too thick. They also can help keep your menstrual cycle regular and reduce cramping. Combination birth control pills containing the hormones estrogen and progestin are a common treatment. Combination pills slightly increase the risk of heart disease, high blood pressure and blood clots. If you smoke or have a medical history of any of these conditions, your doctor may prescribe a progestin-only pill (also called the mini-pill).

Both types of birth control pills can be taken for an extended period of time to control abnormal bleeding.

Intrauterine Device
If birth control pills don't control your bleeding, your doctor may suggest an intrauterine device (IUD). An IUD is a small, plastic device that your doctor inserts into your uterus through your vagina to prevent pregnancy. One type of IUD, a hormone-releasing IUD, also significantly reduces abnormal bleeding.

If you don't want to get pregnant in the future, and if birth control pills or the IUD don't work, two surgical options are available to treat abnormal bleeding: hysterectomy and endometrial ablation.

Laparoscopic supracervical hysterectomy uses a thin, lighted telescope-like instrument called a laparoscope, which acts like a video camera, along with small surgical instruments that are all inserted through three to four tiny incisions (less than 1/4 inch each) in the navel and abdomen. Using the instruments, the surgeon carefully separates the uterus from the cervix and removes it through one of the openings. The cervix, the bottom part of the uterus, is left intact. Because this type of surgery does not require the surgeon to make a large abdominal incision, you will not have the same kind of visible scar typical with most traditional, "open" surgeries.

LSH causes less stress to the body. It was developed to reduce pain, minimize scarring and shorten recovery time. The procedure can be done on an outpatient basis, which means a woman can be home resting comfortably within 24 hours and back to her normal activities in less than a week. As with all surgery, hysterectomy involves risk, including potential blood loss, infection and damage to other internal organs.

LSH preserves the cervix, which some research suggests may help to reduce the risk of pelvic floor prolapse, urinary incontinence and other complications associated with total hysterectomies. Because the cervix is left in place, however, you must be willing to continue annual pap smears to screen for cervical cancer.

The NovaSure procedure is a quick, safe, simple, one-time endometrial ablation treatment. This minimally invasive procedure controls heavy bleeding by using energy to remove the lining of the uterus. The average treatment time is about 90 seconds, and only needs to be performed once to lighten or stop your periods. No pretreatment drugs are required and NovaSure can be performed in the hospital or in your doctor's office.

Without the side effects of hormones or the risks of hysterectomy, NovaSure has a quick recovery time so you can get back to your life sooner. Most women experience no pain after the procedure, and can return to work and regular activities the next day. NovaSure is a procedure for pre-menopausal women for whom childbearing is complete.

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