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Month: September 2016

Abnormal Uterine Bleeding

Abnormal uterine bleeding is a common problem in women’s health. It may present as bleeding that is excess in volume or that occurs at an unexpected time. When a woman sees her physician to evaluate the cause of the abnormal bleeding, the explanation will fall into one of two categories. The first category is an imbalance of hormones (dysfunctional bleeding) that may be treated with hormones such as oral contraceptives or progesterone. The second category is an anatomic change involving a new growth of tissue in the uterus, such as polyps or fibroids (benign muscle tumors), or less commonly, cancer that can develop in the uterine lining. The evaluation may include a pelvic exam (with a pap smear if one has not been done recently), lab work including a pregnancy test, complete blood count, and occasionally hormone tests that check the function of the thyroid and pituitary glands. Pelvic ultrasound is a very useful test, showing the anatomy of the uterus and ovaries. A sonohysterogram is a procedure in which sterile saline is advanced through the cervix into the uterine cavity during the ultrasound. This allows a detailed image of the uterine cavity and may reveal small changes in the lining. An endometrial biopsy may be performed to assess for pre-cancers, cancers, or infection within the lining of the uterus. This specimen is then sent to the pathologist for evaluation. If the pathologist sees evidence of cancer, the treatment plan will include urgent consultation with a cancer specialist and surgery that includes a hysterectomy and cancer staging procedure.

Most often, the abnormal bleeding is found to be due to a benign cause. If cancer has been ruled out, benign growths in the uterine cavity can be removed through an out-patient surgical procedure called hysteroscopy, where a fiber-optic device inserted through the cervix can be used to remove abnormal tissue and restore the uterus to a healthy condition. In cases of dysfunctional bleeding where hormonal treatment does not resolve the problem, a good surgical option is endometrial ablation, a minor procedure where the uterine lining is destroyed. For many women, endometrial ablation is a good alternative to hysterectomy due to the rapid recovery and conservation of normal anatomy.

In summary, abnormal uterine bleeding is a common problem that can be evaluated and managed by hormonal or surgical treatment, depending on the findings. Women who develop abnormal bleeding should promptly see advice from their health care providers for timely diagnosis and appropriate treatment.

Hysterectomy

Having a hysterectomy can be a serious decision and one that should be made carefully. Your physician may have recommended a hysterectomy, but, in many cases it’s optional. You need to be fully informed of your options and the risks and benefits in order to make an informed decision.

Hysterectomy is the surgical removal of the uterus. This procedure ends menstruation and the ability to become pregnant. Therefore, women who want to have children should consider alternatives.

A hysterectomy is only one way to treat problems affecting the uterus. For some conditions, hysterectomy may be the best choice. With uterine or cervical cancer and in cases where a uterine growth causes a blockage of the bladder or intestines, you may have no other option.

The following conditions affect the uterus and require treatment. The treatments may include medication, hysterectomy, or other surgeries:

Uterine fibroids, benign tumors which have increased in size, are painful, or cause bleeding. Hormone medications can be prescribed to shrink uterine fibroids, but they can return when medication is stopped. Medications mimic menopause, so they may also cause symptoms of early menopause. Uterine artery embolization is a non-surgical option performed by a radiologist. During the procedure the uterine artery is blocked and since this artery supplies blood to the fibroid, blocking the flow helps shrink the fibroid. Depending on the severity and positioning of the fibroids, a myomectomy can be performed to remove the fibroids while keeping the uterus intact.

Severe endometriosis, uterine tissue that grows outside the uterus. Since preventing ovulation can reduce the discomfort associated with this endometriosis, oral contraceptives can be used to treat this condition. Hormone medications may also be used to shrink the endometrial tissue. If medications do not effectively treat the endometriosis, laparoscopic surgery may be helpful.

Uterine prolapse, a uterus that has “dropped” into the vaginal canal due to weakened muscles, which can lead to urinary incontinence or difficulty with bowel movements. In some cases, this condition may be improved with Kegel exercises. Since obesity can cause the muscles to stretch, losing weight and quitting smoking can also help relieve pressure on the muscles. Another treatment for uterine prolapse is a pessary, a device inserted in the vagina which holds the uterus and bladder in place. For women past menopause, taking hormones may help keep the pelvic muscles stronger.

Cervical or uterine cancer. Precancerous changes of the cervix which are detected early by a Pap test can be treated with a loop electrosurgical excision procedure (LEEP). LEEP removes the abnormal cells. If the cervical disease moves into deeper layer of tissue or other organs, hysterectomy is usually necessary.

Abnormal bleeding. Treatment for irregular, heavy or severe bleeding depends on the cause. Fibroids, endometrial polyps, hormone level changes, infection, and cancer can all cause abnormal bleeding. Treatments for abnormal bleeding include dilatation and curettage (D&C), hormone medications and nonsteroidal anti-inflammatory medications (NSAIDs.) Hysteroscopic assessment and management may also be effective.

How will you know which treatment is right for you? Based on your condition, you and your doctor should discuss the risks and benefits of each treatment. The treatment used should depend on the nature of your problem and the severity of your symptoms. But, whatever method or option you choose, it’s in your best interest to explore all the treatment options available for your particular condition before choosing hysterectomy.